Colostomy in patients with anorectal malformation with rectoperineal fistula or rectovestibular fistula: a single-center experience

This study summarizes the clinical characteristics of colostomy in children with anorectal malformation (ARM) with rectoperineal fistula (RPF) or rectovestibular fistula (RVF) to inform surgical decision-making. Medical records of children with RPF or RVF undergoing colostomy were retrospectively reviewed to analyze indications. Among 761 rectoperineal fistula and 295 rectovestibular fistula patients, 124 received colostomy: 16 (2.1%) with RPF and 108 (36.6%) with RVF. Indications for colostomy in sixteen RPF were: nonvisible fistula with high Pouch-Perineum (P-P) distance (n = 5), prior colostomy elsewhere (n = 4), penile or scrotal fistula with high P-P distance (n = 2), high P-P distance alone (n = 2), perineal body fistula in a female (n = 1), failed intraoperative pouch identification (n = 1), and necrotizing enterocolitis (n = 1). For rectovestibular fistula (n = 108), indications included: treatment pre-2018 (n = 49, 45.4%), poor general condition or severe anomalies (n = 14, 12.9%), small fistula with persistent distension despite dilation (n = 13, 12.0%), failed prior repair on colostomy (n = 9, 8.3%), neonatal abdominal distension or defecation difficulty (n = 4, 3.7%), fistula near posterior commissure (n = 4, 3.7%), and tethered cord syndrome, reduction of neonatal wound complications, nonvisible fistula with high P-P distance, staged repair choice, or secondary megacolon (each 2.8%, n = 3). For children with fistula at the penis or scrotum and high Pouch-Perineum distance, primary repair carries risks of rectal pouch misidentification and urethral injury. In rectoperineal fistula cases without a visible fistula and with a high Pouch-Perineum distance, colostomy is often unavoidable. A staged surgical procedure is recommended for patients with rectovestibular fistula in cases of poor general condition, severe concomitant congenital malformations, unresolved defecation difficulties following anal dilatation, or a fistula near the posterior commissure.