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.
Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?
First publications on perineal body-preserving PSARP appeared in 2023
epidemiological0:46 ↗
At one year follow-up, perineal body-preserving PSARP demonstrated no dehiscence
clinical0:46 ↗
At one year follow-up, perineal body-preserving PSARP demonstrated no prolapse
clinical0:46 ↗
Only 13% of patients required revision of anal stricture after perineal body-preserving PSARP
clinical0:55 ↗
Two-thirds of patients went home on postoperative day one after perineal body-preserving PSARP
clinicalJill Knepprath1:01 ↗
Perineal body-preserving PSARP technique is the same as what one would do in a bulbar fistula but applied to a vestibular fistula
clinicalNelson1:13 ↗
The technique involves cleaning up the lateral planes before coming around the front
clinicalNelson1:22 ↗
Perineal body-preserving PSARP allows patients to go home earlier postoperatively
clinical1:32 ↗
With perineal body-preserving PSARP, surgeons do not need to worry about breakdown in the perineal body
clinical1:32 ↗
Perineal body-preserving PSARP is harder than opening it all the way anteriorly
opinion1:36 ↗
Conversion to standard PSARP is appropriate if uncertain about location of anterior wall or vagina
guideline1:36 ↗
Perineal body-preserving PSARP can be a trickier approach than standard PSARP
opinionJill Knepprath1:51 ↗
Conversion to standard approach is a valid pivot when in doubt about anatomy
guidelineJill Knepprath2:00 ↗
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 ↗
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