Posterior Sagittal Anorectoplasty for a Recto-vaginal Fistula Occurring 30 Years after Swenson's Operation for Hirschsprung's Disease

We herein report the case of a 37-year-old woman with a recto-vaginal fistula occurring 30 years after Swenson's operation for Hirschsprung's disease. As the patient had undergone multiple abdominal operations in childhood, a rectal pull-through operation was not indicated. The initial procedure of a direct closure of the fistula through the anal approach failed, and a sigmoid colostomy was performed at the same time. As a second procedure, a direct closure using a posterior sagittal approach was attempted and successfully performed. This approach provided a good operational field for performing a direct closure of the fistula. Two months after posterior sagittal anorectoplasty, a stoma closure was performed. The patient is now doing well without any recurrence of the fistula at 10 months after the operation. The experience of this case suggests that the posterior sagittal approach is a useful surgical option for rectal morbidities where abdominal and/or anal approaches are not easily performed.