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Recto-vestibular Fistula
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
For patients undergoing dilations who are not diverted, the perineal body seeing stool right away is a setup for post-operative infection. Update Course Rewind: Perineal Body Sparing PSARP 2023 · 2:00
Update Course Rewind: Perineal Body Sparing PSARP 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Perineal Body Sparing PSARP". Joining the discussion ar
video2:55 · Dec 2023
Preoperative dilations seem to be more tolerated than postoperative dilations; families are worried they will hurt their babies and the repair. 2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma · 17:00
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
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On August 26th, the largest Pediatric Surgery course in the world each year was held, where top hospital experts from around the US will discuss this year’s changes in practices and innovation. Learn more about the future of pediatric surge
video30:29 · Aug 2025
Surgeon does not dilate neovaginas post-operatively, anticipating some patients will need minor revision but avoiding torture of vaginal dilations — Marc Levitt, Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal... · 1:09:37
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
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Drs Marc Levitt, Rama Jayanthi, Carlo Di Lorenzo, and Karen Diefenbach host a half day symposiumhighlighting new concepts and controversies in pediatric colorectal anomalies, primarily focusing on anorectal malformations. This video is an i
video1:28:20 · Jan 2019
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Expert statements from the recordings in this collection.
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
In absent vagina situations with recto-vestibular fistula, the urethra is characteristically enlarged
clinicalMarc Levitt19:47 ↗
Total body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position2:10 ↗
In babies this small, MRI has difficulty delineating uterine and ovarian structures
clinicalMarc Levitt3:21 ↗
Train-of-four box from anesthesia machine is a less expensive alternative to dedicated nerve stimulator for muscle mapping
clinicalMarc Levitt7:47 ↗
Lateral dissection defines the anterior plane in rectal mobilization - first step is to establish clean lateral plane
clinicalMarc Levitt15:16 ↗
In congenital cervical agenesis, there is no evidence that retaining the uterus and connecting to vagina enables successful live births
clinicalDon44:03 ↗
Uterus without cervix has risk of pyometra and ascending infection when connected to outflow tract
clinicalDon44:03 ↗
In surgeon's series of recto-vestibular fistula with no vagina (8 patients), only one had imperforate hymen; none of the others had uterus or fallopian tubes
epidemiologicalDon28:50 ↗
Sigmoid colon pulled down to anus will not function as rectum - lacks same storage qualities and physiologic properties
clinicalDon28:50 ↗
Best time to create neovagina is when rectum has been mobilized; waiting creates scarred perineum making later reconstruction more difficult
opinionMarc Levitt48:12 ↗
Standard neovaginal length in infant is 7-8 centimeters based on normal vaginal length in babies
clinicalMarc Levitt1:05:08 ↗
Surgeon prefers colon over small bowel for neovagina because small bowel mesentery is more tenuous and colon has more robust blood supply
opinionMarc Levitt59:42 ↗
Surgeon does not dilate neovaginas post-operatively, anticipating some patients will need minor revision but avoiding torture of vaginal dilations
opinionMarc Levitt1:09:37 ↗
Six months after breast budding is appropriate timing for pelvic ultrasound and vaginoscopy to assess Müllerian structures and menstrual patency
clinicalMarc Levitt1:09:37 ↗
MRI has limited ability to determine presence of vaginal lumen in very young patients unless there is clear hematocolpos or hydrocolpos
Host summaryMarc Levitt summarizing the discussion — not the host's own clinical position1:22:15 ↗
Neovagina should be tacked to pelvic fascia or posterior bladder to prevent prolapse and ensure it grows with the patient
clinicalMarc Levitt1:08:53 ↗
When fat is visible during rectal dissection, surgeon can safely dissect closer to the bowel wall
clinicalMarc Levitt35:07 ↗
Staple lines should be removed from neovaginal segment rather than left in place
opinionMarc Levitt49:17 ↗
In this patient population, there is thick wall between rectum and urethra in absent vagina situations
clinicalMarc Levitt20:28 ↗
Surgeon would not perform independent examination under anesthesia in straightforward newborn primary anorectal malformation case, but would examine at time of repair
opinionMarc Levitt27:20 ↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
Two variations of perineal body sparing PSARP have been published in the last 6 months, one from Boston and one from Washington DC.
clinicalSteven Lee1:08 ↗
One study has 6 patients and the other has 4 patients.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position1:17 ↗
The techniques are similar but slightly different.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position1:20 ↗
The Boston technique involves a slight posterior sagittal extension of the incision.
clinicalSteven Lee1:26 ↗
These techniques aim to spare the perineal body and preserve long-term gynecologic function for female patients.
clinicalSteven Lee1:30 ↗
The perineal body is important for sexual function and obstetric outcomes in the future.
clinicalSteven Lee1:38 ↗
The Washington DC technique uses an incision just through the sphincter alone, preserving the perineal body skin in its entirety.
clinicalSteven Lee1:49 ↗
For patients undergoing dilations who are not diverted, the perineal body seeing stool right away is a setup for post-operative infection.
clinical2:00 ↗
Perineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position2:12 ↗
2025 Pediatric Surgery Update Course - Updates in Colorectal: Debunking Dogma
Two 2021 studies (one NISQIP, one PCPLC) showed no difference in wound complications, re-operations, or readmissions between early PSARP (less than 7-14 days) and delayed PSARP (6 weeks to 8 months) for female perineal or recto-vestibular fistulas.
Host summaryJamie Harris summarizing the discussion — not the host's own clinical position5:08 ↗
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