MANAGEMENT OF CONGENITAL AND ACQUIRED H-TYPE ANORECTAL FISTULAS IN GIRLS BY ANTERIOR SAGITTAL ANORECTOVAGINOPLASTY

Methods: Thirteen girls with congenital or acquired H-type anorectal f istulae underwent surgery between 1991 and 1996. In all cases, besides a normally placed anal canal, there was a fistulous communication bet ween the anorectum and the genital tract. On the basis of the level of fistulous communication, these cases were divided into three groups: high, intermediate, and low (perineal canal). All patients underwent a nterior sagittal anorectovaginoplasty. Surgical technique included div ision of all intervening tissue in midline between the perineal skin a nd the fistula. The whole fistulous tract was excised, and the remaini ng surrounding tissue was repaired in different layers. Of 13 patients , 12 were operated on without a protective colostomy. Results:There wa s no recurrence in any case, and all patients had good cosmetic result s with a normal sphincter control. Although various techniques have be en suggested for the surgical correction of H-type anorectal fistulae, most of them are applicable only to the low-lying fistula (perineal c anal). Conclusions: To date, there is no satisfactory method available for correction of high fistula. The methods suggested for high fistul a (abdominoperineal pull-through and endorectal pull-through) appear t o be too extensive for this condition. Our technique of anterior sagit tal anorectovaginoplasty can be used not only for low fistula but can also be used for intermediate and high types of fistulae. This techniq ue is simple, safe, takes less time, and achieves good anatomic and fu nctional reconstruction of the perineum. Copyright (C) 1998 by W.B. Sa unders Company.