Abstract
This happens to be, by far, the most common and important anorectal malformation seen in female patients. This defect is extremely important, not only because of its frequency, but also because it has an excellent functional prognosis when treated adequately, and therefore every single pediatric surgeon should be trained to repair this malformation in an impeccable manner, since minor complications may result in serious negative consequences for the patient. The repair of this malformation is illustrated with artwork as well as photographic intraoperative material and animations, with emphasis on the most important technical details to avoid complications. The authors also try to simplify the terminology, avoiding the use of old confusing terms such as “anovestibular” or “vestibular anus.”
-
A.
Rectovestibular fistula with absent vagina: The authors present their experience in the management of a subgroup of patients with vestibular fistula that have no vagina. This particular group is frequently under-recognized, and therefore the authors show important details to suspect and make an early diagnosis. The repair of these malformations, including the creation of a new vagina when this is absent or pull-through of a partially atretic vagina when present, is illustrated with photographs, artwork, and animations.
-
B.
Rectovaginal fistula: A brief description of this malformation and the way to repair it is presented, but more emphasis is placed on the fact that this is the most common misdiagnosis found in the literature in anorectal malformations, particularly in the old literature. In other words, the vaginal fistula is an extremely rare defect, but the term “vaginal fistula” is frequently, erroneously used in cases of rectovestibular fistula and most usually in cases of cloaca. The authors make an effort to avoid this to continue happening.
-
C.
Rectovestibular fistula in adult patients: A significant number of female adults and patients born with vestibular fistula are left untreated. Many of these patients keep that malformation as a secret and seek medical help as adults. Many of the patients had an inadequate procedure during infancy which had serious consequences on the bowel function as well as from the aesthetic point of view. Adult surgeons are not always familiarized with the management of these patients, and therefore, some of these important details are illustrated in this chapter.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
GoLYTELY… (Polyethylene glycol/electrolytes.) Braintree Laboratories, Braintree, MA, USA
References
Cigarroa FG, Kim SH, Donahoe PK (1988) Imperforate anus with long but apparent low fistula in females. J Pediatr Surg 23(1 Pt 2):42–44
Stephens D, Smith D (1971) Chapter 4: Individual deformities in the female. In: Anorectal malformations in children, vol 4. Year Book Medical Publisher, Chicago, pp 81–117
Digray NC, Mengi Y, Goswamy HL, Singh N, Atri MR, Sharma R, Thappa DR (2001) Complete vaginal prolapse: an unusual presentation of anovestibular fistula. Pediatr Surg Int 17(2–3):226–227
Banu T, Hannan MJ, Aziz MA, Hoque M, Laila K (2006) Rectovestibular fistula with vaginal malformations. Pediatr Surg Int 22(3):263–266
Levitt MA, Bischoff A, Breech L, Peña A (2009) Rectovestibular fistula–rarely recognized associated gynecologic anomalies. J Pediatr Surg 44(6):1261–1267. doi:10.1016/j.jpedsurg.2009.02.046
Hanley PH, Hines MO, Stephens JE (1954) Anal sphincter-preserving operation for congenital low rectovaginal or rectoperineal fistula. Am J Surg 88(5):737–745
Stone HB (1936) Imperforate anus with rectovaginal cloaca. Ann Surg 104(4):651–661
David VC (1937) The treatment of congenital openings of the rectum into the vagina—atresia ani vaginalis. Surgery 1(2):163–168
Donovan EJ, Stanley-Brown EG (1958) Imperforate anus. Ann Surg 147(2):203–213
Rosenblatt MS, Gustavson RG (1958) The treatment of congenital malformations of the anus and rectum. Am J Surg 96(2):343–350
Patil UB, Kavouksorian JK (1980) Unusual imperforate anus. N Y State J Med 80(1):87–88
Aluwihare AP (1990) Primary perineal rectovaginoanoplasty for supralevator imperforate anus in female neonates. J Pediatr Surg 25(2):278–281
Simmang CL, Paquette E, Tapper D, Holland R (1997) Posterior sagittal anorectoplasty: primary repair of a rectovaginal fistula in an adult: report of a case. Dis Colon Rectum 40(9):1119–1123
Duhamel B (1960) Le Traitement des anus vulvaires. Ann Chir Infant 1:53–70
Bill AH, Hall DG, Johnson RJ (1975) Position of rectal fistula in relation to the hymen in 46 girls with imperforate anus. J Pediatr Surg 10(3):361–365
Salamov KN, Dultsev YV, Protsenko VM (1987) Surgical treatment of the vestibular ectopia ani in adults. Acta Chir Plast 29(4):209–215
Heinen DFL, Bailez M, Solana J (1992) Malformaciones anorectales I. Fístula vestibular. Area Cirugía. Hospital de Pediatría J.P. Garrahan, Buenos Aires, pp 148–154
Sawicka E (1995) Results of surgical treatment of girls with ano-vestibular fistula. Surg Childh Intern 3(2):94–98
Heinen FL (1997) The surgical treatment of low anal defects and vestibular fistulas. Semin Pediatr Surg 6(4):204–216
Javid PJ, Barnhart DC, Hirschl RB, Coran AG, Harmon CM (1998) Immediate and long-term results of surgical management of low imperforate anus in girls. J Pediatr Surg 33(2):198–203
Martín RS, Molina E, Cerdá J, Estellés C, Casillas MAG, Romero R, Vázquez J (2002) Manejo del ano vestibular en niñas mayors. Cir Pediatr 15:140–144
Rosen NG, Hong AR, Soffer SZ, Rodriguez G, Peña A (2002) Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations. J Pediatr Surg 37(7):961–965
Demirbilek S, Atayurt HF (1999) Anal transposition without colostomy: functional results and complications. Pediatr Surg Int 15(3–4):221–223
Upadhyaya VD, Gopal SC, Gupta DK, Gangopadhyaya AN, Sharma SP, Kumar V (2007) Single stage repair of anovestibular fistula in neonate. Pediatr Surg Int 23(8):737–740
Kumar B, Kandpal DK, Sharma SB, Agrawal LD, Jhamariya VN (2008) Single-stage repair of vestibular and perineal fistulae without colostomy. J Pediatr Surg 43(10):1848–1852. doi:10.1016/j.jpedsurg.2008.03.047
Menon P, Rao KL (2007) Primary anorectoplasty in females with common anorectal malformations without colostomy. J Pediatr Surg 42(6):1103–1106
Upadhyaya VD, Gangopadhyay AN, Pandey A, Kumar V, Sharma SP, Gopal SC, Gupta DK, Upadhyaya A (2008) Single-stage repair for rectovestibular fistula without opening the fourchette. J Pediatr Surg 43(4):775–779. doi:10.1016/j.jpedsurg.2007.11.038
Potts WJ, Riker WL, Deboer A (1954) Imperforate anus with recto-vesical, -urethral-vaginal and -perineal fistula. Ann Surg 140(3):381–395
Carter RF, Lyall D (1940) Congenital rectovaginal defects; operative repair. Surg Gynecol Obstet 71:89–93
Keighley MR (1986) Re-routing procedures for ectopic anus in the adult. Br J Surg 73(12):974–977
Živković SM, Krstić ZD, Vukanić DV (1991) Vestibular fistula: the operative dilemma –cutback, fistula transplantation or posterior sagittal anorectoplasty? Pediatr Surg Int 6:111–113
Grant HW, Moore SW, Millar AJW, Rode H, Cywes S (1994) Is posterior anal transfer a good treatment for vestibular anus? Pediatr Surg Int 9(1–2):12–16
Ando S, Yamaguchi S, Sakasaki Y (1987) Anterior perineal anorectoplasty for intermediate and high imperforate anus. Jpn J Surg 17(3):213–216
Okada A, Kamata S, Imura K, Fukuzawa M, Kubota A, Yagi M, Azuma T, Tsuji H (1992) Anterior sagittal anorectoplasty for rectovestibular and anovestibular fistula. J Pediatr Surg 27(1):85–88
Kulshrestha S, Kulshrestha M, Singh B, Sarkar B, Chandra M, Gangopadhyay AN (2007) Anterior sagittal anorectoplasty for anovestibular fistula. Pediatr Surg Int 23(12):1191–1197
Wakhlu A, Kureel SN, Tandon RK, Wakhlu AK (2009) Long-term results of anterior sagittal anorectoplasty for the treatment of vestibular fistula. J Pediatr Surg 44(10):1913–1919. doi:10.1016/j.jpedsurg.2009.02.072
Shehata SM (2009) Prospective long-term functional and cosmetic results of ASARP versus PASRP in treatment of intermediate anorectal malformations in girls. Pediatr Surg Int 25(10):863–868. doi:10.1007/s00383-009-2434-7
Rizzoli F (1869) Atresia Congenita. Collezione delle memorie. Chirurgiche ed Ostetriche 2:321–357
Mariño Espuelas JM, Martinez Utrilla MJ, Gonzalez Utrilla Y (1988) Consideraciones A La Fistula Vestibular. Cir Pediátr Hosp Infat 1(2):88–90
Matley PJ, Cywes S, Berg A, Ferreira M (1990) A 20-year follow-up study of children born with vestibular anus. Pediatr Surg Int 5(1):37–40. doi:10.1007/BF00179636 10.1007/BF00179636
Author information
Authors and Affiliations
15.1 Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Sagittal view of the surgical repair in a case of rectovestibular fistula (WMV 13664 kb)
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Peña, A., Bischoff, A. (2015). Rectovestibular Fistula. In: Surgical Treatment of Colorectal Problems in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-14989-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-319-14989-9_15
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-14988-2
Online ISBN: 978-3-319-14989-9
eBook Packages: MedicineMedicine (R0)