A Comparative Study of One-stage, Two-stage and Three-stage Posterior Sagittal Anorectoplasty (PSARP) in Female Anorectal Malformations (ARM)


Ashok Laddha, Brijesh Lahoti, Maneesh Jholeya, Aditi Deewan*, Shashi Shankar Sharma, Ram Mohan Shukla, Pooja Tiwari and Yashaswi Choudhury

Context: PSARP has been the standard treatment for ARM since the 1980s. PSARP can be done as a single procedure or as a staged procedure (two-stage or three-stage). Two-stage PSARP is a relatively new concept where colostomy and PSARP are done in the same stage, followed by stoma closure as second stage. Two-stage PSARP is a resource effective method, with minimal incidences of wound complications in the management of female ARM.

Aim: To compare the short-term complications and resource-effectiveness of one- stage, two-stage and three-stage PSARP in female ARM.

Settings and design: A prospective comparative study design was used. Seventy-four females were included in the study and randomly assigned to one of three groups (Groups A, B, and C undergoing one-stage, two-stage, and three-stage surgery, respectively). Patients with common cloaca and the children who did not complete all the stages were excluded from the study.

Methods: Patient‘s demographic data, duration of surgeries, number of days of hospital stay and postoperative complications, including wound infection, dehiscence, anal stenosis and recurrence of fistula were noted. Student’s t test and Oneway ANOVA with post-hoc Tukey HSD Test were used to compare the postoperative complications.

Results: The wound complications were found to be higher in Group A (51.6%) when compared to group B (14.3%) and Group C (4.5%). (p=0.001), whereas the wound complication rates were similar in groups B and C. The total duration of hospital stay and total duration of surgery were the least in group A (7.52 ± 1.91 days) and highest in Group C (16.64 ± 5.76 days). Group B had significantly lesser operative time and total duration of hospital stay than Group C.

Conclusion: A colostomy has a protective effect in preventing wound complications. Both two-stage and three-stage PSARP have similar results in terms of complications and outcome. Two-stage surgery has the additional advantage of omission of one surgery and lesser duration of hospital stays and follows up.