Novel surgical technique for vestibular fistula: single-stage anorectoplasty without perineal incision using fistula inversion

Vestibular fistula (VF) is a common anorectal malformation in females. However, the timing and methods of surgical treatment vary considerably between institutions, mainly because of concerns regarding postoperative complications at the surgical site. This concern primarily relates to the sagittal skin incision extending from the vestibule to the anal region; therefore, we sought ways to minimize its extent. The procedure involved making a skin incision only at the anus, incising the anal sphincter muscle according to the ASARP, and separating the internal fistula tract according to the PSARP. The remaining fistula tract was inverted from the intestinal side and pulled out through the vestibular opening for excision. We report a surgical technique that potentially reduces the concerns and risks of wound complications by avoiding sutured wounds in the perineal skin.