{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:28Z","timestamp":1787004868156,"version":"build-2736575974"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Objective\u2003A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described, which incised only within the limits of the sphincteric ellipse and eliminated an anterior rectal dissection and thus avoiding any possibility of a urethral injury. This report provides longer-term postoperative outcomes after PRAA.<\/jats:p>\n                  <jats:p>Method\u2003A retrospective, single-institution study was performed examining male patients with a rectoperineal fistula between January 2020 and December 2023. PRAA was done only if the rectoperineal fistula was located within the anterior extent of the sphincteric ellipse, which was true for all patients encountered during this study period. We assessed postoperative outcomes, length of stay, time to first feeding, and early stooling patterns.<\/jats:p>\n                  <jats:p>Results\u2003Eighteen patients underwent PRAA at a median age of 5.4 months (range 1 day\u20138 months) with a median follow-up of 14 months (range 4\u201340). Seven patients (39%) were repaired within the first month of life. Thirteen (72%) were repaired primarily and five (28%) had a diverting ostomy placed before referral. There were no instances of wound dehiscence, rectal prolapse, or urethral injury. Two (11%) patients developed an anal stricture requiring dilation or Heineke\u2013Mikulicz anoplasty. All patients resumed feeds on postoperative day one. Median discharge was on postoperative day one (range 1\u20136). Fifteen (83%) were utilizing laxatives at their most recent follow-up.<\/jats:p>\n                  <jats:p>Conclusion\u2003The PRAA avoids any potential urethral injury or perineal dehiscence has a low rate of anal stenosis (11%) and appears to be applicable to all male patients with a rectoperineal fistula. The technique allows for early return to diet and discharge and can be safely done in the neonatal period or in a delayed fashion without the need for a stoma.<\/jats:p>\n                  <jats:p>Level of Evidence\u2003Level III.<\/jats:p>","DOI":"10.1055\/a-2514-7244","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T18:54:48Z","timestamp":1736794488000},"page":"141-146","source":"Crossref","is-referenced-by-count":2,"title":["Anorectal Malformation with Rectoperineal Fistula in Males Treated with a Posterior Rectal Advancement Anoplasty: Report of Early Outcomes"],"prefix":"10.1055","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7014-9415","authenticated-orcid":false,"given":"Thomas O.","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inbal","family":"Samuk","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Schneider Children's Medical Center of Israel, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Wood","sequence":"additional","affiliation":[{"name":"Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Badillo","sequence":"additional","affiliation":[{"name":"Department of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.jpedsurg.2018.02.079","article-title":"Screening practices and associated anomalies in infants with anorectal malformations: results from the midwest pediatric surgery consortium","volume":"53","author":"P C Minneci","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1016\/j.jpedsurg.2021.04.023","article-title":"30-day postoperative outcomes of neonatal versus delayed anoplasty for perineal and vestibular fistulas","volume":"56","author":"C W Marenco","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/S0090-4295(99)80495-6","article-title":"Operative trauma to the genitourinary tract in the treatment of anorectal malformations: 15 years' experience","volume":"47","author":"D Misra","year":"1996","journal-title":"Urology"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.jpedsurg.2013.11.054","article-title":"Outcome of patients after single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification","volume":"49","author":"K WE Chan","year":"2014","journal-title":"J Pediatr Surg"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jpedsurg.2021.12.014","article-title":"The cutback revisited - the posterior rectal advancement anoplasty for certain anorectal malformations with rectoperineal fistula","volume":"57","author":"D R Halleran","year":"2022","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref6","first-page":"173","article-title":"Some congenital deformities of the rectum, anus, vagina and urethra","volume":"8","author":"D Browne","year":"1951","journal-title":"Ann R Coll Surg Engl"},{"key":"ref7","first-page":"309","volume-title":"Operative management of low anomalies in the female","author":"H Nixon","year":"1988"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s00383-010-2697-z","article-title":"Management and outcome of low anorectal malformations","volume":"26","author":"M P Pakarinen","year":"2010","journal-title":"Pediatr Surg Int"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/S0022-3468(78)80315-7","article-title":"Constipation caused by anterior location of the anus and its surgical correction","volume":"13","author":"W H Hendren","year":"1978","journal-title":"J Pediatr Surg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S0022-3468(78)80105-5","article-title":"Anterior ectopic anus: a common cause of constipation in children","volume":"13","author":"L L Leape","year":"1978","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/00000658-197806000-00001","article-title":"A clinical evaluation of the surgical treatment of anorectal malformations (imperforate anus)","volume":"187","author":"E I Smith","year":"1978","journal-title":"Ann Surg"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.jpedsurg.2021.04.022","article-title":"Are routine postoperative dilations necessary after primary posterior sagittal anorectoplasty? a randomized controlled trial","volume":"56","author":"H Ahmad","year":"2021","journal-title":"J Pediatr Surg"},{"issue":"05","key":"ref14","first-page":"children10050846","article-title":"State of the art bowel management for pediatric colorectal problems: anorectal malformations","volume":"10","author":"E Bokova","year":"2023","journal-title":"Children (Basel)"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1053\/jpsu.2002.30810","article-title":"Urologic injuries associated with repair of anorectal malformations in male patients","volume":"37","author":"A R Hong","year":"2002","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.jpedsurg.2006.12.002","article-title":"The posterior urethra in anorectal malformations","volume":"42","author":"J J Mickelson","year":"2007","journal-title":"J Pediatr Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.urology.2023.09.028","article-title":"Posterior sagittal approach provides optimal exposure for urethral reconstruction in children with a history of anorectal malformations","volume":"183","author":"A Tyraskis","year":"2024","journal-title":"Urology"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"2930783","DOI":"10.1155\/2018\/2930783","article-title":"Wound dehiscence after posterior sagittal anorectoplasty in children with anorectal malformations","volume":"2018","author":"L Tofft","year":"2018","journal-title":"BioMed Res Int"},{"key":"ref19","first-page":"93","article-title":"Risk factors for wound dehiscence after posterior sagittal anorectoplasty in children with anorectal anomalies","volume":"29","author":"O Elekiabi","year":"2023","journal-title":"Zagazig Univ Med J"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/01.mop.0000163665.36798.ac","article-title":"Outcomes from the correction of anorectal malformations","volume":"17","author":"M A Levitt","year":"2005","journal-title":"Curr Opin Pediatr"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1055\/a-2019-0030","article-title":"A modification of the anoplasty technique during a posterior sagittal anorectoplasty and anorectal vaginal urethroplasty closure: the para-U-stitch to prevent wound dehiscence","volume":"34","author":"M E Knaus","year":"2024","journal-title":"Eur J Pediatr Surg"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"994249","DOI":"10.3389\/fped.2022.994249","article-title":"Delayed vs. early enteral feeding after repair of congenital recto-vestibular fistula: The effect on perineal wound healing","volume":"10","author":"M Kurdi","year":"2023","journal-title":"Front Pediatr"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.jpedsurg.2022.07.009","article-title":"Early postoperative feeding in single-stage repair of anorectal malformation with vestibular or perineal fistula is not associated with increased wound complications","volume":"58","author":"K Lai","year":"2023","journal-title":"J Pediatr Surg"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1055\/s-0034-1544052","article-title":"Perioperative nutritional management in congenital perineal and vestibular fistulas: a systematic review","volume":"25","author":"M J Hofmeester","year":"2015","journal-title":"Eur J Pediatr Surg"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s00383-020-04629-9","article-title":"General complications after surgery for anorectal malformations","volume":"36","author":"E Divarci","year":"2020","journal-title":"Pediatr Surg Int"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2514-7244.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T19:55:47Z","timestamp":1742846147000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2514-7244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,13]]},"references-count":24,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2025,3,24]]},"published-print":{"date-parts":[[2025,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2514-7244","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1,13]]},"published":{"date-parts":[[2025,1,13]]}}}