From
Dr. Nelson G. Rosen
Timing of PSARP for rectal vestibular fistulas: early versus delayed repair
With Dr. Jamie Harris · hosted by Dr. Jill Knepprath
Chapter 1 of 6
Case presentation
Introduction and case presentation
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No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Initial dilations should be limited to 7 Hegar to decrease potential scarring along the fistula tract for future PSARP
Performing dilations alone is probably not correct management for rectal vestibular fistula, though dilations initially allow for decompression
Dilations need only keep the fistula open enough for soft stool to pass through, with no reason to drive dilation up large
A 2021 multi-institutional retrospective study through PCPLC defined early repair as within 14 days versus late after 14 days, examining 30-day outcomes
There is no consensus in the literature on the right timing for delayed PSARP repair, with definitions ranging from a couple of months to multiple months of age
Theoretical fibrosis of the fistula tract from delayed repair may make dissection more difficult during PSARP
Incomplete decompression can cause rectal distension, making PSARP technically more difficult
Social determinants of health affect families' ability to make multiple trips for care, with long distances and expense being barriers
A 2021 NSQIP study defined early PSARP repair as within 7 days and delayed repair as between 6 weeks and 8 months, finding no difference in overall outcomes including re-operations and readmissions
Wound breakdown and dehiscence was the most common complication for both early and delayed PSARP repair groups, with no significant difference in post-operative complications between groups
Early repair during the newborn period avoids an additional hospital admission for surgery
Both early and delayed PSARP repairs are safe for patients with rectal vestibular fistulas
Timing of PSARP should be determined by family circumstances, patient size, and surgeon comfort and experience