Management of H-type rectovestibular and rectovaginal fistulas

Modified transanal repair of congenital H-type rectovestibular fistula: A technique to avoid recurrence

“…[2,7,8] Furthermore, the variant of H-type fistula seen in Asia tend to follow an inflammatory process, [2,8,9] and are, often, not congenital as occurs in Europe [3] and North America. [5] This condition is also rare in Africa [4] and from the case reported here, the pattern of occurrence may be similar to the congenital variant seen in Europe and America, further confirming geographical variation in the etiology.…”

“…[5] The fistula can be located in the vestibule, vagina or labia. [3,5] In addition to passage of stool through the vagina, H-type fistulas may be associated with anal stenosis or presacral mass and these should be excluded. [5] In the patient presented, neither of these associated anomalies was present.…”

“…[4] H-type rectovestibular or rectovaginal fistulas have been treated by perineal repair, vestibuloanal pullthrough, anterior anorectoplasty and posterior sagittal anorectoplasty. [3,5] The rarity of H-type fistulas, however, has not allowed significant experience in its management by any one paediatric surgeon and recurrence rates, following perineal wound breakdown after repair, have ranged from 5% to 30%. [2,[5][6][7] We recently treated a 7-month-old female who presented to our hospital with a congenital H-type rectovestibular fistula and herein describe the operative technique used to avoid recurrence.…”

“…The distal end of the normal rectal wall (anteriorly) was then pulled down and sutured to the anal canal [ Figure 2b] to ensure that the repaired vestibular wall does not lie against a repaired rectal wall. [5] The perineal body was reconstructed using 4-0 polyglycolic sutures [ Figure 2b]. …”

Anterior perineal fistulectomy in repairing H-type rectovestibular fistula with a normal anus in female children

“…This disorder can be clearly diagnosed according to the history of perineal infection during infancy and the typical leakage of gas or loose stool through vestibular fistular orifice in the presence of a normal anus, usually obviating the need for auxiliary examination [1,2,6]. The vestibular orifice (external orifice) usually is located in the fossae navicularis, or slightly to the left (48/105), but rarely to the right (18/105).…”