ABSTRACT
Perineal fistula, anorectal malformation without fistula, vestibular fistula, cloaca with a common channel less than 3 cm, and recto-bulbar urethral fistula are all ideally repaired with a posterior sagittal approach as the rectum is located below the peritoneal reflection. Since anorectic malformations occur in a spectrum, there are some prostatic fistulas that are closer to a bladder-neck fistula and others that are closer to a bulbar fistula. Sacral defect should be screened for in all patients with an anorectal malformation, since it has important prognostic implications in terms of bowel control. The most common anorectal malformations associated with sacral defects are cloaca and recto-bladder neck fistulas. About 25% of patients with anorectal malformation have tethered cord. It is important to detect its presence since it may negatively affect bowel and urinary control. Mullerian duplication or mullerian septation disorders occur in 60% of patients with cloaca and 6% of patients with vestibular fistula.
