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Eur J Pediatr Surg
DOI: 10.1055/a-2770-2641
Original Article

Anorectal malformation with rectoperineal fistula in females treated with a posterior rectal advancement anoplasty (PRAA) – report of early outcomes.

Authors

  • Thomas Xu

    1   Colorectal And Pelvic Reconstructive Surgery, Children's National Hospital, Washington, United States (Ringgold ID: RIN8404)

  • Julia Ann Ryan

    2   Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, United States (Ringgold ID: RIN8404)

  • Filipa Jalles

    3   Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, United States (Ringgold ID: RIN8404)

  • Arianne M Maya 

    4   Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, United States (Ringgold ID: RIN8404)

  • Christina Feng

    5   Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, United States (Ringgold ID: RIN8404)

  • Richard J Wood

    6   Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, United States

  • Andrea Badillo

    7   Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, United States (Ringgold ID: RIN8404)

  • Marc A Levitt

    8   Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, United States
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Introduction The posterior rectal advancement anoplasty (PRAA) is a novel approach for females with rectoperineal fistulas in which the distal fistula tract lies within the anterior limit of the anal sphincter complex. PRAA eliminates the risk of vaginal injury and perineal body dehiscence while allowing for an appropriately sized and centered anal opening. This study aims to examine complications and outcomes following PRAA. Methods A retrospective, single-institution study was performed of female patients with an anorectal malformation with a rectoperineal fistula between 1/2020-12/2023. PRAA was performed when the rectoperineal fistula was located within the anterior extent of the anal sphincteric ellipse. We assessed time to first feeding, length of stay, and early stooling patterns. Results Twelve patients underwent PRAA at a median age of 171 days with median follow up of 5 months. None were previously diverted with an ostomy. There was no incidence of vaginal injury, wound dehiscence, rectal prolapse, or anal stricture. All were able to resume feeds immediately and were discharged home on postoperative day one. On follow-up, all patients were stooling spontaneously, and nine (75%) were utilizing daily laxatives. Conclusions The PRAA, specifically in female patients with rectoperineal fistula within the anterior limit of the sphincters, eliminates the risk of vaginal injury and perineal body dehiscence. This technique decreases the risk of rectal prolapse and anal stricture, and allows patients to return to their regular diet and home quickly, after only one postoperative day. Longer term data is needed to continue to explore functional outcomes.



Publication History

Received: 12 July 2025

Accepted after revision: 10 December 2025

Accepted Manuscript online:
15 December 2025

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