A 2 m/o baby girl with ARM presenting with recto-perineal fistula that functioning well. No other associated congenital defects.Lateral cross table invertogram confirms it's a low ARM..What to do?
One needs to determine where the sphincter complex is located and then re position the anus in the correct place though a posterior midline incision Colostomy not need.
Of course you know better but first you can consider to perform colostomy. After PSARP, and finally close the colostomy.. I think this is a safer way for both surgeon and patient.
In ARM with rectal vestibular fistula is needed the anus transposition with technical ASARP or PSARP and reconstruction of the perineal body. It is not necessary to perform a colostomy
This rectovestibular fistula requires a mini PSARP. This situation does not require a colostomy but if you are not confident with the limited PSARP technique, you have to either perform a colostomy or send the patient to a tertiary centre. This girl need to have a straight forward surgery if you don't want to have complications later on.
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