S. Kulshrestha et al., Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth, J PED SURG, 35(8), 2000, pp. 1155-1160
Purpose: Posterior sagittal approach was used for the repair of 11 cases of
rectourethral fistula between 1992 and 1998.
Methods: All these patients had rectourethral fistula as a result of perine
al procedure performed for imperforate anus at the time of birth. In additi
on to the fistula repair, an associated anorectal stenosis (3 cases) and ur
ethral stricture (1 case) also were corrected with this approach. All the p
atients underwent surgery under cover of a protective colostomy.
Results: Successful repair was achieved in all patients, and the follow-up
period ranged from 10 months to 7 years, As far as bladder and bower contro
l, urinary control was normal in all 11 patients, whereas bowel control was
normal in 10 cases. One patient who had severe scarring of anal sphincters
caused by infection in the previous surgery still suffers occasional peria
nal soiling after 18 months of follow-up.
Conclusions: Posterior sagittal approach not only gives adequate exposure b
ut also suits the basic principles of fistula repair, namely, completely se
parating the rectum from urethra and leaving normal rectal wall behind the
urethral sutures thus eliminating the possibility of recurrence. In additio
n to fistula repair, one can also correct associated problems like anorecta
l stenosis or urethral stricture, and a mislocated rectum can be relocated
within the sphincter complex. J Pediatr Surg 35-1155-1160 Copyright (C) 200
0 by W.B. Saunders Company.