Experience of using the modified transanal approach in treatment of recurrent rectourethral fistulas in children

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Abstract

Aim. To develop surgical technique for definite treatment of recurrent rectourethral fistula in children.

Materials and methods. From 2010 to 2022, 6 children with anal atresia and recurrent rectourethral fistula after sphincteroplasty were treated. In all patients an isolation and ligation of fistula with bringing down and resection of rectum above the level of fistula using transanal access in prone position was done.

Results. The procedure was successful in all cases. Follow-up duration ranged from 4 months to 5 years. There were no complications. Sphincter function was totally preserved.

Conclusion. Novel proposed method is an effective, reliable and safe procedure to treat recurrent recto-urethral fistulas. This technique provides good view of intestine and urethra without damaging the sphincter and levator structures, and also respects the principle of separating the fistulous tract with total resection of altered segment of the intestine, which eliminates all pathogenetic mechanisms of fistula recurrence.

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About the authors

I. V. Kyrgyzov

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Email: drkirgizov@mail.ru
ORCID iD: 0000-0001-5796-5266

Ph.D., MD, Professor of the Department of Pediatric Surgery named after Academician S.Ya. Doletsky

Moscow

A. E. Minin

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Author for correspondence.
Email: dralexminin@gmail.com

Ph.D., Pediatric urologist of the Pediatric Surgical Department

Russian Federation, Moscow

A. M. Efremenkov

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Email: efremart@yandex.ru
ORCID iD: 0000-0002-5394-0165

Ph.D., Head of the Pediatric Surgical Department

Russian Federation, Moscow

D. V. Sivilob

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Email: dsivolob@yandex.ru

Pediatric surgeon of the Pediatric Surgical Department

Russian Federation, Moscow

R. R. Shakhbanov

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Email: shakhbanov.rafik@mail.ru

pediatric surgeon of pediatric surgical department

Russian Federation, Moscow

I. A. Shishkin

Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation

Email: I.A.Shishkin@mail.ru

Ph.D., Pediatric surgeon of the Pediatric Surgical Department

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. External aspect of the rectourethral fistula orifice in the rectum

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3. Fig. 2. Stage of the operation. Isolation of the rectum

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4. Fig. 3. Stage of the operation. The rectum is mobilized to the level of the rectourethral fistula, into which the forceps are inserted.

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5. Fig. 4. Stage of the operation. The rectourethral fistula is isolated to the urethra. A clamp is inserted into the urethra.

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6. Fig. 5. Stage of the operation. The urethral defect in the fistula area has been sutured. The rectum has been mobilized proximally.

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7. Fig. 6. View after surgery

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8. Fig. 7. Picture of endoscopic examination (urethroscopy). Blind pocket of the bulbar urethra at the site of the rectourethral fistula

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