Vestibular fistula is the most common anorectal malformation in females. Traditionally managed with a staged posterior sagittal anorectoplasty (PSARP) following colostomy, concerns remain regarding colostomy-related morbidity. Intra-operative, early, and late postoperative complications, and functional outcomes (voluntary bowel movements, soiling, and constipation) were compared between secondary PSARP (after colostomy) and primary PSARP (without) using appropriate statistical tests. Functional outcomes were comparable, with >90% achieving voluntary bowel movements. Thus, we conclude that primary PSARP is a safe and effective treatment, avoiding colostomy-related morbidity. Colostomy should be reserved for selected cases.
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