Transperineal Tension-free Repair of Rectal Seromuscular Layer for Acquired Rectovestibular Fistula in Girls
10.3969/j.issn.1009-6604.2024.04.003
- VernacularTitle:经会阴直肠浆肌层无张力修补术治疗女童后天性直肠舟状窝瘘
- Author:
Mao YE
1
;
Qi LI
;
Zhen CHEN
;
Yuanyuan GENG
;
Xu LI
Author Information
1. 首都儿科研究所附属儿童医院普外科,北京 100020
- Keywords:
Rectovestibular fistula;
H-type fistula;
Anorectal malformation;
Fistula repair
- From:
Chinese Journal of Minimally Invasive Surgery
2024;24(4):250-254
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the effectiveness of transperineal tension-free repair of rectal seromuscular layer in the treatment of acquired rectovestibular fistula.Methods Clinical data of 97 girls with acquired rectovestibular fistula from May 2016 to November 2023 were enrolled.The surgical age ranged from 6 months to 11 years old(median,3 years old).The fistula was disconnected and resected via the perineal approach.The anterior wall of the rectum was fully disconnected.Then the fistula was repaired with horizontal continuous tension-free suture of rectal plasmomuscular layer with 5-0 PDS sutures.After continuous suture reinforcement,the perineal muscle layer and skin were longitudinally continuously sutured.The internal fistula opening was exposured with an anal dilator or small hook,and the mucosal layer was continuously sutured with 5-0 PDS sutures.Postoperatively,the anal tube and urinary tube were retained for 5-7 d and antibiotics was administered for treatment.Results The mean operation time was(60.5±9.0)min,the mean fistula diameter was(5.2±2.1)mm,and the mean hospital stay was(7.4±1.9)d.The follow-ups time was 4.5 months to 8.5 years(median,4.25 years).Primary healing was achieved in 92 cases(94.8％),with satisfactory perineal appearance,smooth stool passage,and regular defecation.Fistula recurred within 5-10 d after operation in 5 cases(5.2％),2 of which healed after 3 weeks of sitz baths by using 3％boric acid or Kangfuxin solution,2 of which healed after second operation,and 1 of which experienced recurrence after secondary fistula repair.Conclusion Transperineal tension-free rectal seromuscular layer repair is a simple,safe,and effective surgical method for the treatment of acquired rectovestibular fistula in girls.
