Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth

S Kulshrestha, M Kulshrestha, A Yadav, B Singh, I P Elhence, A N Gangopadhyay, B Sarkar, V Tewari
Journal of Pediatric Surgery 2000, 35 (8): 1155-60

PURPOSE: Posterior sagittal approach was used for the repair of 11 cases of rectourethral fistula between 1992 and 1998.

METHODS: All these patients had rectourethral fistula as a result of perineal procedure performed for imperforate anus at the time of birth. In addition to the fistula repair, an associated anorectal stenosis (3 cases) and urethral stricture 11 case) also were corrected with this approach. All the patients underwent surgery under cover of a protective colostomy.

RESULTS: Successful repair was achieved in all patients, and the follow-up period ranged from 10 months to 7 years. As far as bladder and bowel control, urinary control was normal in all 11 patients, whereas bowel control was normal in 10 cases. One patient who had severe scarring of anal sphincters caused by infection in the previous surgery still suffers occasional perianal soiling after 18 months of follow-up.

CONCLUSIONS: Posterior sagittal approach not only gives adequate exposure but also suits the basic principles of fistula repair, namely, completely separating the rectum from urethra and leaving normal rectal wall behind the urethral sutures thus eliminating the possibility of recurrence. In addition to fistula repair, one can also correct associated problems like anorectal stenosis or urethral stricture, and a mislocated rectum can be relocated within the sphincter complex.

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