title: Treatment of adults with unrecognized or inadequately repaired anorectal malformations: 17 cases of rectovestibular and rectoperineal fistulas.
abstract: OBJECTIVE
  To analyze all cases of congenital rectovestibular and rectoperineal fistulas diagnosed and treated later in life, and to describe presenting complaints, treatment, and outcome.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Pediatric surgery departments of 3 major referral centers in the US and Europe.
  
  
  METHODS
  Seventeen women with untreated or inadequately treated rectovestibular or rectoperineal fistulas.
  
  
  METHODS
  Analyses of all eligible patients: charts were analyzed for the classification of the malformation, main complaints, continence, sexual function, indications for surgery, associated anomalies, surgical procedure, complications, and outcome.
  
  
  METHODS
  Patients' complaints, continence, constipation, and sexual function.
  
  
  RESULTS
  Major complaints at time of diagnosis were fecal incontinence, and concerns for hygiene and cosmesis. All patients were repaired by a posterior sagittal approach. In all but 1 patient the complaints disappeared or improved after surgery.
  
  
  CONCLUSIONS
  Anorectal malformations in females are congenital malformations mostly seen and treated in early childhood. If unrepaired or inadequately repaired the patient, when reaching adulthood, can suffer from significant morbidity. Surgical treatment is similar as in childhood and has an excellent clinical outcome.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. i.deblaauw@erasmusmc.nl
authors.forename: Ivo
authors.initials: I
authors.lastname: de Blaauw
authors.forename: Paola
authors.initials: P
authors.lastname: Midrio
authors.forename: Lesley
authors.initials: L
authors.lastname: Breech
authors.forename: Andrea
authors.initials: A
authors.lastname: Bischoff
authors.forename: Belinda
authors.initials: B
authors.lastname: Dickie
authors.forename: Hendt P
authors.initials: HP
authors.lastname: Versteegh
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000473:pathology; D003251:Constriction, Pathologic / Q000209:etiology; D004414:Dyspareunia / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005402:Fistula / Q000150:complications / Q000151:congenital / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012003:Rectal Fistula / Q000150:complications / Q000151:congenital / Q000601:surgery*; D012005:Rectal Prolapse / Q000209:etiology; D012006:Rectovaginal Fistula / Q000150:complications / Q000151:congenital / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014599:Uterus / Q000002:abnormalities; D014621:Vagina / Q000002:abnormalities; D055815:Young Adult