ABSTRACT
This procedure is performed in cases of rectovestibular fistula in female babies. The incision is very similar to the one just described but it is extended more cephalad as far as necessary to achieve enough bowel mobilization. The main difference in comparison with the previous defect lies in the fact that the rectum and vagina share a rather long common wall. The most important part of the operation consists in separating the rectum and vagina by creating a plane of separation without injuring either one (Fig. 56.24). The separation is carried out all the way up until both structures have a full-thickness normal wall. Lack of mobilization is the main cause of recurrences and dehiscence after this repair. The separation of the rectum from the vagina requires a meticulous and delicate technique and is performed with a needle-tip cautery, changing from cutting to coagulation where
necessary to provide meticulous hemostasis (Fig. 56.24). Once the rectum has been completely separated, the limits of the external sphincter are determined by electrical stimulation. This will indicate where the rectum should be located. The perineal body is then reconstructed with interrupted stitches of long-term absorbable sutures (Fig. 56.25a). The rectum is anchored to the posterior edge of the muscle complex (Fig. 56.25b) and then a 16-stitch anoplasty is performed in the same way as previously (Fig. 56.25c,d). The suture recommended is a 5-0 long-term absorbable one. These patients can have oral feedings the same day of surgery and can go home the following day. Bacitracin ointment is applied to the wound three times a day for 1 week.
