Rectovestibular Fistula

Abstract

This happens to be, by far, the most common and important anorectal malformation seen in female patients. This defect is extremely important, not only because of its frequency, but also because it has an excellent functional prognosis when treated adequately, and therefore every single pediatric surgeon should be trained to repair this malformation in an impeccable manner, since minor complications may result in serious negative consequences for the patient. The repair of this malformation is illustrated with artwork as well as photographic intraoperative material and animations, with emphasis on the most important technical details to avoid complications. The authors also try to simplify the terminology, avoiding the use of old confusing terms such as “anovestibular” or “vestibular anus.”A.Rectovestibular fistula with absent vagina: The authors present their experience in the management of a subgroup of patients with vestibular fistula that have no vagina. This particular group is frequently under-recognized, and therefore the authors show important details to suspect and make an early diagnosis. The repair of these malformations, including the creation of a new vagina when this is absent or pull-through of a partially atretic vagina when present, is illustrated with photographs, artwork, and animations.B.Rectovaginal fistula: A brief description of this malformation and the way to repair it is presented, but more emphasis is placed on the fact that this is the most common misdiagnosis found in the literature in anorectal malformations, particularly in the old literature. In other words, the vaginal fistula is an extremely rare defect, but the term “vaginal fistula” is frequently, erroneously used in cases of rectovestibular fistula and most usually in cases of cloaca. The authors make an effort to avoid this to continue happening.C.Rectovestibular fistula in adult patients: A significant number of female adults and patients born with vestibular fistula are left untreated. Many of these patients keep that malformation as a secret and seek medical help as adults. Many of the patients had an inadequate procedure during infancy which had serious consequences on the bowel function as well as from the aesthetic point of view. Adult surgeons are not always familiarized with the management of these patients, and therefore, some of these important details are illustrated in this chapter.