Repair of Congenital H-Type Vestibuloanorectal Fistula Through the Posterior Midsagittal Approach: Case Report

Abstract

The posterior midsagittal approach was successfully used for the repair of congenital H-type vestibuloanorectal fistula in a patient 1.5 months old. Technical details of the operation which consisted of two main parts are described. Identification and dissection of the fistulous tract started following midsagittal division of the sphincters and the posterior half of the rectum with the patient in a knee-chest position. The dissected part of the fistulous tract was inverted per vagina. Completion of dissection and excision of the fistulous tract were accomplished with the patient in the lithotomy position. The main advantage of the procedure was the ability to completely excise the fistula under direct vision.

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

“…Rectovestibular fistula with normal anus has been considered a congenital ARF in some reports and has also been referred to as H-type anorectal fistula [1,5,6], N-type fistula [7], or double termination of the alimentary tract [2,3,8]. Other investigators believe that it is an acquired condition [9][10][11][12].…”

The surgical management of H-type rectovestibular fistula: a case report and brief review of the literature

“…Unroofing the fistula via a transverse perineal incision is an effective approach with a low recurrence rate The vestibular fistula site is similarly closed [8], but it divides the perineal body, increasing the risk of anal sphincter dysfunction. The posterior sagittal anorectoplasty (PSARP), which is the standard approach for patients with imperforate anus, can also be an effective technique in H-type fistulas [2,9]. We believe that this extensive procedure is more complicated than the condition warrants, often necessitating a diverting colostomy, and also carries the risk of incontinence and sphincter dysfunction.…”