Clinical Features and Surgical Procedures of Acquired Rectovestibular Fistula: A Single-center Retrospective Study

Abstract

Introduction

We reviewed a 7-year experience (Jan 2016 to Oct 2023) in diagnosing and surgically treating Acquired Rectovestibular Fistula (ARVF). Our study describes the medical history, introduces new classifications based on fistula features, and outlines the application of diverse surgical techniques in treating these patients.

Methods

A total of 78 girls with ARVF appeared asymptomatic at birth. Most patients experienced diarrhea or perineal inflammation within their first three months of life, followed by fistula formation and occasional fecal leakage and gas from the vestibule. The median age at surgery was 4 years (7 months–11 years). Fistulas were classified into four types based on diameter, location, and number, with corresponding surgical procedures: Type I (n = 52) underwent transrectal repair; Type II (n = 17) underwent transrectal fistulectomy and repair; Type III (n = 7) and Type IV (n = 2) underwent rectal-vestibular pull-through fistula excision or complete destruction, followed by transrectal repair.

Results

Primary healing occurred in 76 patients (97.4 %), with discharge occurring within 5–7 days postoperatively. Complications arose in 2 cases: one involved a Type IV fistula incision infection that resolved with daily sitz baths, and the other involved a Type III fistula recurrence that necessitated reoperation. All 78 patients had normal perineal appearance, with no incidences of urinary or fecal incontinence or anal stricture during the 2-month to 6-year follow-up period.

Conclusions

Choosing an appropriate surgical approach based on fistula classification for treating Acquired Rectovestibular Fistula (ARVF) leads to high success rates, low incidence of complications, and a favorable prognosis.