title: Endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula.
abstract: OBJECTIVE
  Rectourethral (RUF) or rectovaginal fistula (RVF) is a troublesome complication after anorectal surgery because of dense adhesions around the fistula. The authors applied a new technique for the redo surgery.
  
  
  METHODS
  Case 1 is Hirschsprung's disease in a 1-year-old boy who underwent modified Duhamel's procedure and had RUF. Case 2 is rectovestibular fistula in an 11-year-old girl who had anterior sagittal anorectoplasty complicated by RVF. Case 3 is multiple urogenital anomalies including rectovesical fistula in a 4-year-old boy in whom transvesical repair was unsuccessful. The colon was mobilized as far as possible at laparotomy. The rectum was opened via a posterior sagittal approach leaving 1 cm of the anal canal. Extended endorectal mucosectomy was performed to the dentate line, and the fistula was closed from inside of the rectum. The remaining mucosal cuff was everted out of the anus and the intact colon was pulled through the rectum and anastomosed to the cuff extraanally.
  
  
  RESULTS
  The postoperative contrast enema showed no recurrent fistula, and defecation was not impaired.
  
  
  CONCLUSIONS
  Endorectal pull-through of the intact colon can spare troublesome mobilization of the fistula and can prevent the recurrence of fistula. Rectal incision via a posterior sagittal approach provides a direct view of the fistula.
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kubota
authors.forename: H
authors.initials: H
authors.lastname: Kawahara
authors.forename: H
authors.initials: H
authors.lastname: Okuyama
authors.forename: T
authors.initials: T
authors.lastname: Oue
authors.forename: Y
authors.initials: Y
authors.lastname: Tazuke
authors.forename: Y
authors.initials: Y
authors.lastname: Ihara
authors.forename: S
authors.initials: S
authors.lastname: Nose
authors.forename: A
authors.initials: A
authors.lastname: Okada
authors.forename: K
authors.initials: K
authors.lastname: Shimada
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012003:Rectal Fistula / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000601:surgery; D012007:Rectum / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*