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Purpose <p>To investigate associated anomalies and the postoperative defecation function in female patients with low-type anorectal malformations (ARMs), focusing on comparing anovestibular fistula (AVF) with other subtypes.</p> Methods <p>Patient data were collected between 1984 and 2021. Eighty-seven female patients with low-type ARMs were enrolled after excluding one undetermined case. Associated anomalies, operative procedures, and the long-term defecation function were analyzed and compared between the AVF and non-AVF groups.</p> Results <p>AVF was the most common subtype (52.9%), followed by anocutaneous fistula (21.8%), covered anal stenosis (11.5%), anovulvar fistula (10.3%), and covered anal complete (3.4%). Upper urinary tract anomalies and VACTERL association were significantly more frequent in AVF (17.4% and 13.0%) than in non-AVF. Specific associations were identified: trisomy 21 with covered anal complete (100%), perineal groove with anocutaneous fistula (10.5%), and MRKH syndrome with AVF (2.2%). Chronologically, non-AVF low-type ARMs achieved “excellent” evacuation scores at 6 years, whereas AVF patients typically achieved this by 9 years. Individual defecation parameters reached full scores by 7 years in all subtypes except AVF, where constipation persisted beyond 11 years.</p> Conclusion <p>The postoperative defecation function in female patients with low-type ARMs demonstrates differential improvement patterns, with AVF requiring extended management until at least 9 years.</p>

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Anovestibular fistula versus other subtypes in female patients with low-type anorectal malformation: differential patterns in defecation function improvement and associated anomalies at a single institution

  • 期刊论文

  • 发表日期：

    2026年2月21日

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  • Toshio Harumatsu,
  • Ayaka Nagano,
  • Koshiro Sugita,
  • Yumiko Tabata,
  • Nanako Nishida,
  • Chihiro Kedoin,
  • Yudai Tsuruno,
  • Masakazu Murakami,
  • Keisuke Yano,
  • Shun Onishi,
  • Koji Yamada,
  • Waka Yamada,
  • Takafumi Kawano,
  • Motofumi Torikai,
  • Tatsuru Kaji,
  • Satoshi Ieiri

摘要

Purpose

To investigate associated anomalies and the postoperative defecation function in female patients with low-type anorectal malformations (ARMs), focusing on comparing anovestibular fistula (AVF) with other subtypes.

Methods

Patient data were collected between 1984 and 2021. Eighty-seven female patients with low-type ARMs were enrolled after excluding one undetermined case. Associated anomalies, operative procedures, and the long-term defecation function were analyzed and compared between the AVF and non-AVF groups.

Results

AVF was the most common subtype (52.9%), followed by anocutaneous fistula (21.8%), covered anal stenosis (11.5%), anovulvar fistula (10.3%), and covered anal complete (3.4%). Upper urinary tract anomalies and VACTERL association were significantly more frequent in AVF (17.4% and 13.0%) than in non-AVF. Specific associations were identified: trisomy 21 with covered anal complete (100%), perineal groove with anocutaneous fistula (10.5%), and MRKH syndrome with AVF (2.2%). Chronologically, non-AVF low-type ARMs achieved “excellent” evacuation scores at 6 years, whereas AVF patients typically achieved this by 9 years. Individual defecation parameters reached full scores by 7 years in all subtypes except AVF, where constipation persisted beyond 11 years.

Conclusion

The postoperative defecation function in female patients with low-type ARMs demonstrates differential improvement patterns, with AVF requiring extended management until at least 9 years.