Anterior sagittal anorectoplasty as a technique for the repair of female anorectal malformations: A twenty two-years-single-center experience Ahmed Elrouby ⁎, Saber Waheeb, Ahmed Koraitim Pediatric Surgery Department, Alexandria University, Egypt abstract article info Article history: Received 20 November 2018 Received in revised form 6 March 2019 Accepted 8 April 2019 Available online xxxx Key words: Female anorectal Posterior sagittal Anterior sagittal Continence Background: Anorectal malformations (ARMs) are major congenital malformations occurring in female children in approximately 1 out of every 4000–5000 births. Posterior sagittal anorectoplasty (PSARP) was introduced for their treatment in early 1980s by Pena and Devries. However, anterior sagittal anorectoplasty (ASARP) was first introduced by Okada as a modification of the previous technique. Purpose: The aim of this study was to report our experience and the long-term follow-up results of 594 female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. We chose this approach as the incision is smaller, with minimal cutting of the external sphincter and easier dissection of the vagina and rectum. The type of our study was retrospective study. Results: The study included 594 patients; 342 of them were less than 1 year old. About 526 patients had rectovestibular fistula, anterior perineal anus in 55 patients, anocutaneous fistula in 6 patients and rectovaginal fis- tula in 7 patients. All of these patients had been subjected to ASARP technique which had been done in one stage without proceeding colostomy in about 470 cases and in staged fashion with a protective colostomy in 124 patients. Postoperative follow up revealed that four patients (0.7%) developed anal retraction, 30 patients (5%) developed anal stricture, 20 patients (3.4%) had rectal prolapse and 40 patients (6.7%) developed anterior anal migration. Constipation was observed in 161 patients (27%) by the end of 1st postoperative year reduced to 41 patients (7%) after one year. 474 patients were assessed for continence by Kelly's continence score and 453 patients showed good result, 16 patients showed fair result and about 5 patients had poor continence outcome. Conclusion: Anterior sagittal anorectoplasty is a procedure with optimal functional outcome especially at if done at an early age in one stage without preliminary colostomy. © 2019 Elsevier Inc. All rights reserved. Anorectal malformations (ARMs) are major congenital malformations in female children, occurring in approximately 1 out of every 4000–5000 births. On average, 70% of the female anorectal malformations are low, 17% are intermediate while 13% are high. Many procedures were used for correction of these anomalies but their outcome was not satisfactory. One of these procedures was the posterior sagittal anorectoplasty (PSARP) which was introduced in the early 1980s by Pena and Devries being done through a large incision extending to the coccyx dividing the whole external sphincter complex [1]. Another procedure was described by Okada who described the an- terior sagittal approach (ASARP) for correction of female anorectal anomalies. This approach utilized the same basic principles as that of the posterior one with a much smaller incision extending only to the midpoint of the proposed new anus with only the anterior fibers of external sphincter complex being divided. Also, the dissection of the vagina and rectum, which is considered the most important step of the operation, takes place under direct vision in ASARP [2]. The aim of this study was to report our experience and the long-term follow-up results of female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. 1. Patients and methods Our retrospective study included 594 female patients with anorectal anomalies admitted and operated on at our Pediatric Surgery Department from March 1996 to March 2018. Patients with sacrospinal anomalies were excluded from our study. The patients' records were reviewed and the age at which the repair was done, as well as the type of the anomaly (rectovestibular, anovestibular, anterior perineal anus, rectovaginal fistula or anocutaneous fistula) was recorded. All of the studied patients were treated by ASARP technique either under cover of a proximal stoma (staged) or without a proximal stoma (one stage). Journal of Pediatric Surgery xxx (xxxx) xxx ⁎ Corresponding author at: 2 Omar Zafan St. Alexandria, Egypt. Tel.: +20 01223631687. E-mail addresses: elroubypaedo@yahoo.com ahmed.elrouby@alexmed.edu.eg (A. Elrouby), saberwaheeb@gmail.com (S. Waheeb), a_koraitim@hotmail.com (A. Koraitim). YJPSU-59181; No of Pages 4 https://doi.org/10.1016/j.jpedsurg.2019.04.008 0022-3468/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: A. Elrouby, S. Waheeb and A. Koraitim, Anterior sagittal anorectoplasty as a technique for the repair of female anorectal malformations: A twenty two-years-single-center..., Journal of Pediatric Surgery, https://doi.org/10.1016/j.jpedsurg.2019.04.008