All types of congenital anorectal malformations require surgical treatment. However, depending on the type of deformity, the size of the fistula, etc., there can be different operation times and methods. The current surgical methods include: fistula resection, layered suture, rectal moving flap repair, sacral abdominal perineum surgery, etc.
The purpose of surgery is to restore normal bowel function. Recto-vaginal fistulas have complicated causes, various types, post-operative infections, and high recurrence rates. It is difficult to perform operations again. To achieve a successful operation, the choice of surgical methods is extremely important.
1. Layered suture of fistula resection
After the fistula is excised and sutured in layers, it can be repaired through the vagina or rectum. The advantage is simple operation and easy operation. The disadvantage is that the recurrence rate is high. Due to the tension during suture, the separation of rectal or vaginal tissue is uneven, so the mucosal muscle flap must have sufficient blood supply.
2. Rectal moving valve repair
In 1902, Noble first used rectal moving valve repair to treat rectovaginal fistula. Recently, most scholars believe that this method should be the first choice for repairing low rectal fistula.
Three, sacral abdominal perineum surgery
Since the levator ani muscle of newborns is only about 1.5cm from the anus, it is easy to damage the puborectal ring when separating the rectum from the perineum. The sacrococcygeal incision can clearly distinguish the puborectal ring, it is easy to free the rectum, and it is easier to separate and remove the fistula with a higher fistula. Surgery is suitable for children over 6 months after birth.
For congenital anal malformations and rectovaginal fistulas, please note:
① Surgical methods and operating methods;
②Whether the free rectal end is sufficient;
③Avoid serious infection;
④Fully loosen the end of the rectal mucosa to suture without tension.
Anal atresia combined with low rectovaginal scaphoid fistula: If the fistula is very small and has difficulty defecation after birth, it can be stoma in the neonatal period. If the fistula seems to be very close to the vaginal opening, an anoplasty will be performed after 4 to 5 years of age. If the vaginal fistula is large and the fecal discharge is unobstructed, early surgery is not necessary. Surgery is more appropriate to 3 to 5 years old.
For acquired rectovaginal fistulas, especially those with iatrogenic rectovaginal fistulas, the timing of surgery should be carefully selected, and surgery should be avoided immediately due to the urgent request of the patient. The operation should wait for all inflammation to subside and the scar to soften, and it should be performed 3 months after the injury or repair. If the fistula is large, wait 6 months. At the same time, all inflammation must be properly drained