Vestibular Fistula
Everything in the library about vestibular fistula — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
4 items
Surgical Management Of Female Anorectal Malformation Patients Including...
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This video focuses on treatment of the female infant, focusing on the reconstructive aspect of the genitourinary tract and Cloaca. Featuring panel discussions and case presentations by Dr. Marc Levitt.
video57:59 · Nov 2018
Imperforate Anus Rapid Fire: Update Course 2015
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Dr. Jason Frischer of Cincinnati Children's Hospital Medical Center, presents on imperforate anus.
video6:54 · Jan 2019
Anorectal Malformation Management of Female Patients Part II: Pediatric...
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Drs Marc Levitt, Rama Jayanthi, Carlo Di Lorenzo, and Karen Diefenbach host a half day symposiumhighlighting new concepts and controversies in pediatric colorectal anomalies, primarily focusing on anorectal malformations.
video28:20 · Jan 2019
Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?
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In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Nelson Rosen, Annie Le-Nguyen, Elizabeth Speck, Aaron Garrison, and Jamie Harris explore a key surgical debate: classic PSARP vs. the perineal body–p
video2:13 · Apr 2026
Case-Based Learning
1 item
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
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DirectorsDrs Marc Levitt andAlbertoPena, and Todd Ponsky,along with faculty includingDrs Atsuyuki Yamataka, Paola Midrio, Long Li, Uvi deBlaauw, Sabine Sarnacki, Nguyen Thanh Liem, Luis de la Torre, and Marcela Bailez,discuss pediatric colo
video31:29 · Sep 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Surgical Management Of Female Anorectal Malformation Patients Including...
In every single redo of a female anorectal malformation, areolar tissue is found that had never been dissected by the original surgeon, suggesting inadequate anterior rectal wall mobilization led to perineal body disruption.
clinicalMark6:38 ↗
The rectal blood supply is intramural, so injuring the rectal wall during dissection hurts its blood supply.
clinicalMark14:12 ↗
Starting lateral dissection before attempting to separate the common anterior wall is key; the lateral plane defines the anterior plane.
host_summaryMark14:34 ↗
Coming in from lateral to anterior and starting more proximally (where structures are easier to separate) rather than at the perineum improves the dissection plane.
host_summaryMark15:25 ↗
A systematic review found that early enteral nutrition appears better than later nutrition in anorectal malformation repair, but all studies were retrospective and poor quality.
host_summaryMark19:54 ↗
About 2 to 5% of vestibular fistulas have a vaginal septum that should be identified at the time of rectal repair.
epidemiologicalMark27:40 ↗
Women with longitudinal vaginal septum often learn to work around it for intercourse and may be asymptomatic, but menstrual hygiene (tampon use) is a major reason for resection.
host_summaryMark30:32 ↗
Vaginal septum resection in adolescents is not a difficult operation and can be done with electrocautery, getting as close to the cervix as possible without damaging it.
host_summaryMark31:29 ↗
If a vaginal septum is found in a 6-year-old after anorectal malformation repair, there is no rush to remove it before puberty unless another operation is planned.
host_summaryMark42:29 ↗
Of 33 patients with vestibular fistula and absent vagina, 75% had urologic problems including neurogenic bladder, and 50% had CKD stage 3 or greater.
epidemiological37:17 ↗
Vestibular fistula with absent vagina requires aggressive urologic screening due to high rates of solitary kidneys, reflux, hydronephrosis, neurogenic bladder, and urinary tract infections.
clinical37:31 ↗
For absent vagina with vestibular fistula, sigmoid neovagina is preferred, using sigmoid colon mobilized laparoscopically and brought to the perineum, with backup colostomy.
host_summaryMark34:56 ↗
The ideal time to create a neovagina is when fixing the rectum, because the perineal body is open and the sigmoid pedicle reaches more easily in younger children with shorter pelvis.
opinionMark39:35 ↗
About 50% of cloacas have a bifid gynecologic system.
epidemiologicalMark45:50 ↗
For newborn cloaca with hydrocolpos, an open divided colostomy should be performed, and the vagina decompressed with a pigtail catheter rather than formal vaginostomy.
host_summaryMark46:12 ↗
Cystoscopy at the time of colostomy creation in cloaca makes the colostomy creation very difficult and should be avoided; scope at 2–3 months instead.
host_summaryMark46:48 ↗
Intermittent catheterization of the cloaca 2–3 times daily can drain urine from the vagina and avoid the need for vaginostomy tube in many cases.
host_summaryMark51:09 ↗
Catheterization of cloaca should be done under ultrasound guidance initially to ensure the catheter enters the correct structure (right vagina, left vagina, bladder, or rectum).
clinicalMark52:02 ↗
In hydrocolpos compressing the ureters, once the hydrocolpos is drained, the bladder fills beautifully, demonstrating the physiology of ureteral compression.
host_summaryMark53:50 ↗
Most patients with hydrocolpos can be successfully drained by draining the hydrocolpos only, without needing to drain the bladder separately.
clinicalMark54:04 ↗
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
For vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life
host_summaryEm Gootee0:34 ↗
Primary repair is preferred in the neonatal period with a very nice fistula; older patients may require colostomy
clinical1:14 ↗
Primary repair can be performed up to 3-4 months of age if surgeon is confident; otherwise two-operation approach is used
clinical1:32 ↗
Teenagers repaired with classical three-operation approach have beautiful perineum and perfect function
clinical2:28 ↗
Patients repaired primarily 7-8 years ago have more stenosis and adhesions because feces pass through during healing even with fasting
clinical2:57 ↗
Vestibular fistula patients with normal sacrum and no cord have excellent prognosis with good operation
clinical3:46 ↗
For babies born in hospital, operate within first 72 hours before colonization occurs
clinical4:34 ↗
For 6-month-old baby with megacolon, clean colon with GoLYTELY completely, then central line with 7-10 days NPO on parenteral nutrition before repair
clinical4:58 ↗
Oval-shaped anus with no radiating streaks is very specific for Currarino syndrome
clinicalSabine6:35 ↗
Presacral mass corresponds to either anorectal stenosis (mass just in front of stenosis) or Currarino syndrome
clinicalSabine7:43 ↗
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