ASARPAs Soon As Reasonably Possible
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In Group A patients, NSARP and in group B patients ASARP was performed.
In group B, dilation of fistula was required in 4 patients (33.33%) before planning ASARP.
Intraoperative vaginal injury occurred in one patient (6.66%) of NSARP group whereas 3 patients (20%) of ASARP group required repair of vaginal wall while making two walls from one common wall.
Out of 12 patients in NSARP group who were on regular follow-up, 9 patients had good bowel habits with 1-3 bowel movements per day as compared to 6 patients from ASARP group who had 1-3 motions per day.
Constipation with less than one bowel movements in 3 days with requirement of occasional enema was observed in 1 patient of NSARP group as compared to 3 patients of ASARP group who complained of constipation.
Stenosis of neoanus was observed in 1 patient of ASARP group which was managed conservatively with repeated anal dilation with Hegar's dilator.
No patients of both NSARP and ASARP group had soiling or frank incontinence of stool during follow up.
In NSARP group, 6 patients had excellent cosmetic score of 3 with parents fully satisfied as compared to 4 patients in ASARP group who recorded a score of 3.
Patient's manoeuvring during dissection was uneventful and subjectively better in all 24 cases of ASARP
ASARP was introduced by Okada in 1992 for treatment of rectovestibular and anovestibular fistula (6,7) The advantages of ASARP over the previously mentioned techniques are: Separation of posterior vaginal wall from rectum which is considered the most important step of the operation, surgery under direct vision the rectum is placed and anchored within the muscle complex and the perineal body is accurately reconstructed.
The ASARP procedure is recommended even for the management of perineal trauma in female children.
Table 1: Complications during ASARP Complications Number of Patients Haemorrhage 0 Vaginal wall tear 2 Rectal wall injury 0 Wound infection 3 Wound dehiscence 1 Table 2: Followup after ASARP Followup Anal stenosis 1 Anal stricture 0 Mucosal prolapse 0 Constipation 3 Incontinence 0