Vaginal reconstruction in anorectal malformations: A 17-year single-center experience
Journal of Pediatric Surgery, cilt.61, sa.11, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 61 Sayı: 11
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.jpedsurg.2026.163403
- Dergi Adı: Journal of Pediatric Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Anahtar Kelimeler: Anorectal malformation, Vaginal reconstruction, Persistent cloaca, Rectovestibular fistula, Vaginoplasty, Introitoplasty, Mullerian anomaly
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background/Purpose: Vaginal anomalies frequently accompany anorectal malformations (ARMs) in females, yet management strategies remain poorly standardized. This study presents our 17-year single-center experience with vaginal reconstruction in ARM patients with documented Müllerian and/or vaginal anomalies, focusing on surgical decision-making, technique selection, and outcomes. Methods: This study was conducted retrospectively on all children with ARMs who had documented Müllerian and/or vaginal anomalies who underwent vaginal reconstruction at our tertiary referral center between January 2004 and January 2021. Patient demographics, ARM types, vaginal anomaly types, associated anomalies, surgical approaches, vaginal reconstruction techniques, complications, and long-term outcomes were analyzed. Categorical variables were compared using Fisher's exact test. Results: Eighteen patients underwent vaginal reconstruction: 11 (61%) had persistent cloaca (PC), 6 (33%) had rectovestibular fistula with anal atresia (RVFAA), and 1 (6%) had cloacal exstrophy. Eleven patients (61%) had duplicated vaginas; distal vaginal agenesis was present in 6 (33%). Associated anomalies were highly prevalent: vertebral (72%), gastrointestinal (39%), urinary (39%), cardiac (27%), and VATER/VACTERL association (22%). Mean age at definitive surgery was 2.50 ± 1.53 years. Vaginal reconstruction methods included introitoplasty (28%), vaginal septum excision (33%), and vaginal replacement using bowel segments and/or rectovestibular fistula tissue (33%). Mean achieved vaginal length was 60.56 ± 13.16 mm. Complications occurred in 44% of patients, predominantly wound dehiscence (33%) and fistula formation (28%). Fistula formation was significantly associated with prior wound dehiscence (p < 0.001). Mean follow-up was 7.18 ± 3.66 years (range 2.3–14.3 years). Conclusions: Vaginal anomalies in ARMs require individualized reconstruction approaches. No single technique is universally applicable. The surgical algorithm should prioritize maximal native vaginal tissue use, appropriate replacement tissue selection when needed, protective colostomy for complex cases, and long-term follow-up through puberty.