Efficacy of laparoscopic assisted anoplasty in the treatment of intermediate type rectovestibular fistula.

OBJECTIVE: This study aimed to assess the efficacy of laparoscopic-assisted anoplasty in treating intermediate type rectovascular fistula (IRVF) in pediatric patients. METHODS: Between July 2016 and July 2024, 24 children diagnosed with IRVF underwent laparoscopic-assisted anoplasty at the Affiliated Hospital of Zunyi Medical University. The average age at the time of surgery was 5.26 months, ranging from 1.5 to 20 months. Among them, three patients underwent enterostomy in the neonatal period and laparoscopic anoplasty in the second period. Perioperative data and postoperative complications were collected, and use Krickenbeck score to follow up and evaluate children's anal function. RESULTS: All 24 children successfully underwent laparoscopic-assisted anal plasty without requiring conversion to open surgery. There were no instances of incision infection, vaginal injury, fistula recurrence, anal stenosis, or other complications. Postoperative rectal mucosal prolapse occurred in one patient but improved after the intervention. One patient with complex congenital heart disease was transferred to the PICU and treatment was discontinued. During follow-up, defecation function evaluation was performed in 13 children older than 2.5 years. Among them, 10 achieved autonomous defecation control. Nine children had no or grade 1 fecal incontinence, three had grade 2 fecal incontinence, and one had grade 3 fecal incontinence. Eight children experienced no or grade 1 constipation, while four had grade 2 constipation, and one had grade 3 constipation. The parents expressed satisfaction with the appearance of the child's anus, and no cases of anal displacement were observed. CONCLUSION: Laparoscopic-assisted anoplasty is a surgical approach for intermediate type rectovestibular fistula treatment.