Management of congenital and acquired H-type anorectal fistulae in girls by anterior sagittal anorectovaginoplasty

Methods: Thirteen girls with congenital or acquired H-type anorectal fistulae underwent surgery between 1991 and 1996. In all cases, besides a normally placed anal canal, there was a fistulous communication between the anorectum and the genital tract. On the basis of the level of fistulous communication, these cases were divided into three groups: high, intermediate, and low (perineal canal). All patients underwent anterior sagittal anorectovaginoplasty. Surgical technique included division of all intervening tissue in midline between the perineal skin and the fistula. The whole fistulous tract was excised, and the remaining surrounding tissue was repaired in different layers. Of 13 patients, 12 were operated on without a protective colostomy. Results:There was no recurrence in any case, and all patients had good cosmetic results with a normal sphincter control. Although various techniques have been suggested for the surgical correction of H-type anorectal fistulae, most of them are applicable only to the low-lying fistula (perineal canal). Conclusions: To date, there is no satisfactory method available for correction of high fistula. The methods suggested for high fistula (abdominoperineal pull-through and endorectal pull-through) appear to be too extensive for this condition. Our technique of anterior sagittal anorectovaginoplasty can be used not only for low fistula but can also be used for intermediate and high types of fistulae. This technique is simple, safe, takes less time, and achieves good anatomic and functional reconstruction of the perineum. Copyright (C) 1998 by W.B. Saunders Company.