PMC7479256_01
Anovestibular fistula with openings of urethra and vagina. There was no anal opening.
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Physical examination (Fig. 1), revealed that there were urethra, labia majora, labia minora with small vaginal introitus.
Ultrasonography.
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Transfistula anorectoplasty technique (A). Circumference incision was performed in vestibule. Several fine silk traction sutures insertion around the fistula orifice. (B) Separation of the rectum from the posterior vaginal wall was conducted by sharp dissection. Meticulous dissection of anorectum about 4 to 5 cm length was performed to prevent vaginal damage or musculature surrounding the rectum. Spinchter muscle was identified and by using the index finger as a marker, v-shaped incision is made through the anal canal. (C) Anoplasty was performed with apposition of vestibular wound using PGA 3.0. (D). Rectal tube number 11 was inserted, vagina and perineal body was reconstructed with modified Fenton procedure; vestibular wound was closed with PGA 2.0 interrupted stitches, bulbospongiosus muscle was sutured using PGA 2.0 and posterior vaginal mucose was sutured using PGA 2.0.
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We performed anogenital reconstruction with transfistula anorectoplasty and modified Fenton procedure (Fig. 3).
Three months follow up.
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Caesarian section is considered to be safe procedure to prevent damage on anal sphincter and vagina (Fig. 4).