The surgical treatment of H-fistula with normal anus in girls

Abstract

The surgical treatment of children with H-fistula is one of the understudied problems of the present day, especially regarding its high rates of complications. The surgical technique of bringing down the anterior wall of rectum in clinical practice allows us in reducing the rate of H-fistula recurrences. The results of our studies have shown the substantial advantages of the suggested method compared to the traditional ones. The aim of this work was the improvement of methods of surgical correction of H-fistulas in female children with normal anus. From 1994 to 2008, 28 children have been operated for H-fistulas with normal anus in our elective surgery department. The first group consisted of 8 children who were operated for invaginated fistula extirpation. The second group of 2 children underwent a dissection and fistula suture through transperineal access. The third group consisted of 18 patients who were operated for an anterior anorectoplasty with fistula extirpation and pull-through of the anterior wall of the rectum outside the anal canal. The patients age varied from 3 to 8 years. The diagnoses were based on clinical manifestation, X-ray examination, endoscopy and histological tests. In 6 patients, from the first group soiling and gas production through the surgical wound were observed; in 5 of them, fistulas recurred, in 1 patient the fistula was closed with diverticulum of rectum. Only 2 patients had satisfactory results. All patients from the second group with rectovaginal fistulas had recurrences. The 18 patients from the third group had not recurred. In 5 children, fecal soiling disappeared after conservative rehabilitation measures. H-fistula with normal anus in females is a complicated malformation demanding a surgical correction in specialized proctologic clinics. The method of anterior anorectoplasty with fistula extirpation and pull-through of the anterior wall of the rectum is pathogenically valid and is the method of choice in treatment of H-fistula in children.