Recto-vestibular Fistula
Everything in the library about recto-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
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Update Course Rewind: Perineal Body Sparing PSARP 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Perineal Body Sparing PSARP". Joining the discussion ar
video2:55 · Dec 2023
Evidence & Research
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2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
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On August 26th, the largest Pediatric Surgery course in the world each year was held, where top hospital experts from around the US will discuss this year’s changes in practices and innovation. Learn more about the future of pediatric surge
video30:29 · Aug 2025
Case-Based Learning
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Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
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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. This video is an i
video88:20 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
Two studies in 2021 found no difference in wound complications, re-operations, or readmissions between early (less than 7-14 days) and delayed (6 weeks to 8 months) PSARP for vestibular fistulas
clinicalJamie Harris5:14 ↗
Wound breakdown and dehiscence was the most common complication in both neonatal and delayed PSARP groups, occurring in approximately 5-6% with no significant difference between groups
clinicalJamie Harris6:00 ↗
For vestibular fistula dilations, recommend only dilating to 7 Hegar to decrease potential scarring along the tract for future PSARP
clinicalJamie Harris2:33 ↗
Perineal body-preserving PSARP showed no dehiscence, no prolapse, and only 13% required revision of anal stenosis at one-year follow-up in 2023 publication
clinical10:22 ↗
Two-thirds of patients undergoing perineal body-preserving PSARP went home on postoperative day one
clinical10:36 ↗
Perineal body-preserving PSARP does not add operative time compared to standard PSARP
clinicalJamie Harris14:03 ↗
Anal dilations are associated with parental anxiety, PTSD for both patients and caregivers, and post-traumatic stress symptoms in families
clinical16:31 ↗
Preoperative dilations appear to be more tolerated than postoperative dilations
opinion17:00 ↗
In Spanish study, children adequately sized at initial post-PSARP appointment did not receive dilations, while undersized children received dilations
clinical17:19 ↗
Single institution review showed 2 children in each group (dilations vs no dilations) required re-operation for neoanal stricture, and approximately 15% required Heineke-Mikulicz stricturoplasty
clinical18:01 ↗
PCPLC retrospective study of Hirschsprung disease found no difference in preoperative enterocolitis, postoperative enterocolitis, or fecal incontinence between neonatal pull-through (median 11 days) and delayed primary pull-through (median 98 days)
clinicalNelson Rosen20:25 ↗
Multi-center retrospective study found 24% of Hirschsprung patients received at least one Botox injection
epidemiologicalNelson Rosen23:40 ↗
Cincinnati Children's prospective study (2020-2024, unpublished) found decreased risk of enterocolitis within 31 days after pull-through in patients receiving Botox (30% vs 50%)
clinicalNelson Rosen23:58 ↗
Patients receiving Botox at time of pull-through had higher risk of diaper rash (60%)
clinicalNelson Rosen24:23 ↗
Early work from Boston used per-kilogram Botox dosing up to maximum of 100 units
clinicalNelson Rosen24:58 ↗
Rate of concurrent Hirschsprung disease and anorectal malformation is approximately 2% based on Pena's series
epidemiological27:03 ↗
Some papers show rate of concurrent Hirschsprung and ARM as high as 3-4%, while recent paper showed less than 1%
epidemiological27:14 ↗
Single center study found ganglion cells in 90% of rectal fistula specimens taken during PSARP, with hypoganglionosis or absent ganglion cells in the rest
clinical27:39 ↗
Patients with both Hirschsprung disease and anorectal malformation tend to have chromosomal anomalies, particularly trisomy 21
clinical28:24 ↗
Fistula dilations represent controlled tears when starting from pinhole size, not true stretching
clinicalNelson Rosen8:41 ↗
Goal of fistula dilation is to maintain patency just large enough for soft, mustardy stool to pass through
clinicalNelson Rosen4:17 ↗
Perineal body-preserving PSARP is essentially the same technique used for bulbar fistula applied to vestibular fistula
clinicalNelson Rosen11:04 ↗
Key technical principle for perineal body-preserving PSARP is to mobilize lateral planes and back wall thoroughly before coming around the anterior common plane
clinicalNelson Rosen11:32 ↗
Perineal body-preserving PSARP can be converted to standard PSARP by extending the incision if visualization is inadequate
clinicalJamie Harris13:09 ↗
Families competent with irrigations will start treatment for enterocolitis before calling the surgeon
opinion21:36 ↗
Patients with longer aganglionic segments who cannot be adequately decompressed at home may require earlier pull-through to prevent enterocolitis or perforation
clinical22:07 ↗
Some data suggests possibly better continence in delayed Hirschsprung pull-through group, but studies have been underpowered
clinical22:39 ↗
Ultrasound guidance for Botox injection allows visualization of needle placement, internal and external anal sphincter layers, superficial external anal sphincter, and sometimes puborectalis
clinical25:48 ↗
Absence of ganglion cells in fistula tissue does not necessarily mean Hirschsprung disease, as fistula tissue is not physiologic tissue
clinical27:54 ↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
In absent vagina situations with recto-vestibular fistula, the urethra is characteristically enlarged
clinicalMarc Levitt19:47 ↗
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