Surgical Outcomes and Tissue Repair Mechanisms Following Anorectal Plasty for Rectovestibular Fistula in Female Children: A Narrative Review

Alisher Arintay, Assylzhan M. Messova, Sagira T. Abdrakhmanova, Makhmutbay Sanbayev

2026

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DOI 10.4103/wkmj.wkmj_59_26
Data confidence 70 medium
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Abstract

A BSTRACT Background: Rectovestibular fistula (RVF) is the most prevalent subtype of anorectal malformation (ARM) in female children. Despite widespread adoption of posterior sagittal anorectoplasty (PSARP), anterior sagittal anorectoplasty (ASARP), and emerging minimally invasive approaches, a comprehensive synthesis of contemporary surgical outcomes, tissue repair mechanisms, and quality-of-life data remains lacking. Objective: The objective of this study was to systematically synthesize current evidence on surgical techniques, wound healing biology, functional outcomes, complications, and quality of life (QoL) following anorectal plasty for RVF in female children. Methods: A search was performed in PubMed/MEDLINE, Scopus, and Web of Science (2025–2026). The studies meeting prespecified eligibility criteria (RVF or female ARM, anorectoplasty or relevant tissue biology, and original peer-reviewed data) were included and synthesized narratively. Results: Thirteen studies were included. PSARP (primary and staged), ASARP, trans-sphincter anorectoplasty, one-step proctoplasty, laparoscopic-assisted anorectoplasty, and perineal body-preserving PSARP were evaluated. Wound dehiscence ranged from 0% to 63.4% depending on technique; anal stricture occurred in 0%–30% of cases. ASARP demonstrated shorter hospital stay and lower infection rates than PSARP in a prospective comparison. Anorectal angle on magnetic resonance imaging strongly correlated with continence ( r = −0.831). Histopathological studies confirmed universal moderate-to-severe distal rectal fibrosis and smooth muscle dysplasia. QoL, measured by Pediatric QoL 4.0, was high (mean 94/100) in resource-limited settings despite suboptimal care access. Conclusions: Anorectal plasty provides satisfactory functional outcomes in most female children with RVF. Primary repair in selected neonates is safe and avoids colostomy-related morbidity. ASARP may offer short-term wound outcome advantages. Laparoscopic approaches demonstrate comparable safety with potential recovery benefits.