Treatment of pediatric H-type rectovestibular fistula with rectal-vestibular pull-through inside-out

Objective As a rare anorectal malformation in children, rectovestibular fistula without anal atresia is caused by congenital anorectal malformation or postnatal infection. Surgery is the only treatment. Different approaches have certain postoperative recurrence rates. Here the method of rectal-vestibular pull-through inside-out plus endorectal mucosal advancement flap was introduced. Methods The relevant clinical data were collected from September 1999 to September 2006 at Affiliated Shanghai Children's Hospital and from October 2008 to July 2015 at Shanghai Xinhua Hospital. The same operative team performed a total of 16 procedures of rectal-vestibular pull-through inside-out plus endorectal mucosal advancement flap. The median age was 4 (1-15) years. Preoperative bowel preparation was performed with enema at a previous night and suppository glycerolon the same morning. Postoperative fasting lasted for 1 to 3 days and discharge occurred within 5 to 8 days. Results During a follow-up period of 10 months to 15 years, there was no onset of recurrence, incontinence or anorectal stricture. Conclusions Using rectal-vestibular pull-through inside-out and endorectal mucosal advancement flap is both simple and efficacious for rectovestibular fistula. And it is worthy of wider popularization. Key words: Rectovestibular fistula; Anus; Digestive system Surgical procedures