Laparoscopically Assisted Anorectal Pull-Through for Rectocloacal Fistula

Abstract

Successful laparoscopically assisted anorectal pull-through combined with simultaneous posterior skin flap vaginoplasty is reported.

Case Report:

A 13-month-old girl who underwent initial sigmoidostomy at birth presented with a rectocloacal anomaly: a double vagina and intermediate confluence of the urogenital sinus with a high type of rectovaginal fistula. She simultaneously underwent a laparoscopically assisted anorectal pull-through and a posterior skin flap vaginoplasty. After vaginoplasty, the distal rectum was laparoscopically dissected and the rectovaginal fistula was divided. A laparoscopic muscle stimulator 5 mm in diameter showed good contraction of the levator muscles in the pelvic floor. With laparoscopic visualization, a guidewire and a balloon catheter were inserted into the center of the levator muscle sling and muscle complex, and dilation of the pull-through tract was achieved. Rectal pull-through and anastomosis between the rectum and anus were successfully completed. The operation took 4.25 hours, and blood loss was minimal.

Conclusions:

Laparoscopy and the laparoscopic muscle stimulator provide excellent visualization of the rectovaginal fistula and levator muscle sling. Better visualization of the tract facilitates successful rectal pull-through.