[Treatment of vestibular fistulas in older girls]

The vestibular fistula is the anorectal malformation more frequent in females. In this congenital anomaly the anus is located in the vaginal vestibule, having the rectum a common wall with the vagina. With the posterior sagittal approach described by Alberto Peña it changes the treatment of this anorectal malformation, contributing to the possibility of an aesthetic and functional improvement. From 1996 we have operated on 6 girls with ages included between 6 and 22 years (mean of 11 years) that presented a vestibular fistula. Five cases had been operated on in the neonatal period of vestibular fistula carrying out "cut-back", and a case had been operated on for cloaca syndrome. It was carried out in all of them, posterior sagittal approach disecting the rectum, separating it from the vagina and placing it in the sphincter. In a case a colostomy was carried out and in the other five were carried out intestinal cleaning, maintaining absolute diet and postoperative total parenteral nutrition. The evolution has been favorable in all the cases. the functionality of the neo-anus in terms of continence is absolutely normal, presenting an excellent aesthetic aspect. We believe that the posterior sagittal approach is suitable as surgical treatment of the vestibular fistula. The aesthetic improvement and the satisfaction of our patients motivates us to the realization of this technique that also allows us to correct in only one surgical act associated vaginal malformations.