Rectovaginal Fistula

A 9-month-old female with anorectal malformation had a rare malformation with normal urethra, normal vagina, and a rectal fistula high in the vagina

The patient underwent initial colostomy

In a similar case, a septum of the vagina was found which needs to be removed at the time of rectal repair

Laparoscopy was performed using 5 millimeter ports in the umbilicus, bilateral upper and right lower quadrants

The distal rectum was dissected all the way to its insertion below the peritoneal reflection in the back of the vagina

The distal rectum's blood supply was dependent on the inferior mesenteric artery and this was preserved

This dissection was similar to the one done for males with rectal bladder neck or high rectal prosthetic fistulas

The fistula is divided using electrocautery, and a preloaded PDS endo loop is placed over a 3 millimeter Maryland clamp on the divided fistula and the distal rectum

A perineal incision is performed at the site of the planned anoplasty after the muscle complex is stimulated and marked

The distal rectum is grasped and pulled through under laparoscopic control without twisting it

Vicral sutures are placed from the posterior edge of the muscle complex incorporating the posterior wall of the rectum to allow the rectum to lay within the muscle complex

Placing the rectum within the muscle complex which lies along either side of the rectum helps to avoid rectal prolapse

The anoplasty is performed with multiple interrupted stitches of the rectum to the perianal skin at the center of the sphincter