Vestibulo-Rectal Pull Through in H-Fistula in Girls

Area of Science:

• Pediatric Surgery
• Colorectal Surgery
• Anorectal Malformations

Background:

• H-fistulas in girls are complex anorectal malformations requiring specialized surgical techniques.
• The Vestibulo-rectal pull-through (VRPT) is a described surgical approach for managing these fistulas.

Purpose of the Study:

• To present the surgical experience and outcomes of 47 cases of H-fistula in girls treated with the VRPT technique.
• To evaluate the efficacy and safety of VRPT in achieving fistula closure and preserving cosmetic results.

Main Methods:

• The study included 47 female patients with H-fistulas, including one recurrent case.
• A circumferential vestibular incision was utilized to dissect and invaginate the fistula tract into the bowel lumen.
• The fistula tract was excised, and the rectal lumen was closed internally; perineal body repair was performed via the vestibular incision. No protective colostomy was performed in the study cohort.

Main Results:

• A complete cure was achieved in 45 out of 47 cases (95.7% success rate).
• Two early cases experienced recurrence, potentially due to inadequate mobilization, but later cases showed no recurrence.
• The procedure avoided incisions on the perineal skin or anal verge, enhancing cosmetic outcomes.

Conclusions:

• The Vestibulo-rectal pull-through (VRPT) is an effective surgical treatment for H-fistulas in girls, yielding high success rates.
• VRPT offers a viable alternative to other surgical methods by avoiding the need for colostomy and improving cosmetic results.
• The technique's ability to achieve internal closure and avoid external incisions contributes to favorable patient outcomes.