Diversities of H-type anorectal malformation: a systematic review on a rare variant of the Krickenbeck classification.
Congenital H-type fistula is a rare congenital rectourogenital connection with an external anal opening in a normal or ectopic position. A systematic review was done to study the anatomical types of congenital H-type fistula, embryology, clinical presentation, relative gender distribution, associated anomalies, investigative modalities, and recent advances in treatment of these lesions. A PubMed search included H-type anorectal malformation; H-type anorectal malformations; H-type anorectal; and H-type congenital anorectal that gave 9;43;76;26 abstracts, respectively. Relevant studies and cited articles were studied omitting duplicate search. The reported incidence is 0.1-16 % of all anorectal malformation. The H-type anorectal malformation is 2.5-6 times more common in females and usually associated with a normal anus. In males, the anomaly is usually a variant with an ectopic anus or a perineal fistula. Anatomical types include anovestibular; rectovestibular; rectovaginal fistula in females and rectourethral (bulbar, prostatic, bladder neck) and rectovesical fistula in males. Variants identified include H-type fistula with perineal fistula, perineal groove, H-type sinus, H-type canal, and acquired H-type fistula. This review compiles the available literature over last six decades. Various surgical corrective procedures have been described. The high recurrence decreases with a learning curve and experience.
Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India. drshilpas@gmail.com.
Shilpa
S
Sharma
Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
Devendra K
DK
Gupta
D001003:Anal Canal / Q000002:abnormalities*; D000071056:Anorectal Malformations / Q000145:classification*; D005260:Female; D006801:Humans; D012007:Rectum / Q000002:abnormalities*
Anorectal malformation; H-type ARM; H-type fistula
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