Surgical repair of rectovestibular fistula with normal anus

Purpose: The aim of this study was to evaluate the authors' surgical approa ch and technique in patients with congenital rectovestibular fistula with a normal anus (CRF). Methods: During the period between 1981 and 1995, 19 girls from 2 months to 13 years of age were treated surgically for CRF by a primary perineal appr oach. After appropriate bowel preparation, the patient was placed in a lith otomy position. A probing catheter was placed in the fistula, A perineal tr ansverse skin incision was made on the midpoint between the posterior commi ssure and the anus, and the underlying tissue was dissected. The fistula wa s divided, and the both ends were closed by interrupted sutures. The extern al sphincter muscle was mobilized to interpose between the vestibular and r ectal stumps of the fistula. Postoperative feeding was begun on day 6. Results: A protecting colostomy was created in the early 4 patients. Fiftee n patients underwent a primary fistula division without colostomy. In those without colostomy, 1 patient had a reopening of the fistula 6 days after t he primary repair. In this patient, colostomy was created, and the fistula was divided 6 months later by the same approach. After a follow-up of 3 to 17 years, all patients have normal bowel habit. Conclusion: A primary perineal approach is appropriate for the treatment of CRF. Copyright (C) 1999 by W.B. Saunders Company.