Rectovestibular fistula with normal anus: a simple resection or an extensive perineal dissection?

Management of H-type rectovestibular and rectovaginal fistulas

“…The presence of a recurring labial abscess in infancy was the "red flag" in one of our patients, which has been reported by others [1,4]. In a review of 182 patients with Htype fistulas from China, the incidence of a prior perineal inflammation or vulval abscess was quite high with 86% having a history of vulval inflammation [9]. The fistulas in that series were probably all acquired in contrast to what we and others have noted [1,2,6,8].…”

“…These malformations are consistently noted to be rare in Western countries [1][2][3][4][5]. Much larger series are reported from Asia [6,7,9]. The reason for the geographical variation remains unexplained but has been suspected to be related to acquired fistulas related to an inflammatory process such as a perianal abscess [1,2,6,9].…”

“…Much larger series are reported from Asia [6,7,9]. The reason for the geographical variation remains unexplained but has been suspected to be related to acquired fistulas related to an inflammatory process such as a perianal abscess [1,2,6,9]. H-type fistulas represent 14% of the ARMs seen in females in India and Japan [6,7] compared with 3.2% of 629 patients (males and females) with ARMs in a report from Finland [1].…”

“…The incidence in studies from Asia, for unknown reasons, is greater and has been reported to be as high as 7% to 14% of all ARMs in females [6,7]. Management options described in the literature have included perineal repair, vestibuloanal pull-through, anterior perineal anorectoplasty, and a limited or formal posterior sagittal anorectoplasty (PSARP), with a reported recurrence rate of 5% to 30% [1,5,6,8,9]. We describe our technique of managing this rarely encountered problem, reviewed the patients we treated, and analyzed their outcomes.…”

Rectovaginal fistula in a dog with a normal anus: a case report

“…The use of stool softeners resulting in watery faeces might have potentially played a role in increasing the contamination from faecal material that constantly dribbled onto the incisional site. In the secondary surgery, the rectal segment containing the defect was resected completely along with the surrounding inflammatory tissue, leaving a fresh wound with a clean border, which has been recommended in human medicine (Li et al 2010). Antibiotic prescription was changed according to the antimicrobial susceptibility test results, and faecal contamination of the surgical site was minimised with the rinse and application of the ointment.…”