Ano-vestibular and recto-vestibular fistulae with normal anus : is the surgical approach the same ?

الملخص EN

We report a series of 3 female pediatric patients (6-13 months) with very rare variants of anorectal malformations namely ano-vestibular and rectovestibular fistulae, with normal anus trying to answer whether they should be handled differently in terms of surgical repair.

None of the patients was diagnosed early after birth.

The patients presented with fecal leakage from the vestibule, vulvar infection or abscess.

All patients had a barium study to delineate the fistula.

The vestibular fistula opening was located in the midline or in close proximity to it, and the internal opining was located at the anterior wall of rectum.

According to internal orifice site, two of the Three patient were diagnosed as ano-vestibular fistula, while the third was diagnosed to have recto-vestibular fistula.

Two cases with ano-vestibular fistula were managed by simple resection of the tract, whereas the remaining case with recto-vestibular fistula needed anterior sagittal anorectoplasty (ASARP).

The results were satisfactory in all cases without reported recurrence.

We believe that the simple resection is the procedure of choice to repair the ano-vestibular fistula.

On other hand, ASARP and other procedures that requires extensive perineal dissection might be necessary to repair the rectovestibular fistula.