Journal of pediatric surgery · 2026
Single-Stage Versus Staged Repair of Rectovestibular Fistula in Girls: A Systematic Review and Meta-analysis.
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Messova Assylzhan M, Sanbayev Makhmutbay, Alisher Arintay
Аннотация
PURPOSE: The optimal repair strategy for rectovestibular fistula remains uncertain. We compared single-stage with staged repair and estimated complication and functional-outcome rates across operative techniques.
METHODS: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception through May 20, 2026. Studies of girls with congenital anorectal-malformation-associated rectovestibular fistula undergoing definitive repair were eligible. Random-effects models pooled logit-transformed single-arm proportions and risk ratios (RRs) for direct comparisons. Risk of bias was assessed with design-specific tools and certainty with GRADE. The protocol was prospectively registered in PROSPERO (CRD420261436081).
RESULTS: Twenty-six core studies were included; 25 contributed to meta-analysis. Pooled proportions were 10.1% for wound infection (95% confidence interval [CI], 5.2%-18.7%), 8.1% for anal stenosis/stricture (95% CI, 5.1%-12.5%), 7.4% for rectal or mucosal prolapse (95% CI, 4.7%-11.4%), 3.4% for fistula recurrence (95% CI, 1.4%-8.2%), and 23.0% for constipation among age-eligible children (95% CI, 14.0%-35.3%). Single-stage repair was associated with more wound infection than staged repair (RR, 1.86; 95% CI, 1.10-3.16) and suggested more wound dehiscence/disruption (RR, 2.41; 95% CI, 1.00-5.83). Both comparisons were unadjusted and nonrandomized. No clear differences were found for anal stenosis, constipation, soiling, or voluntary bowel movements. Sensitivity analyses gave consistent results.
CONCLUSIONS: Single-stage repair was associated with a higher reported risk of wound infection, but this unadjusted, nonrandomized association is susceptible to confounding by indication and cannot establish causality; certainty was low. Evidence was insufficient to determine whether staging affects anal stenosis or age-eligible bowel outcomes. Decisions regarding fecal diversion should therefore remain individualized pending prospective comparative evidence.
PROSPERO: CRD420261436081.
METHODS: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception through May 20, 2026. Studies of girls with congenital anorectal-malformation-associated rectovestibular fistula undergoing definitive repair were eligible. Random-effects models pooled logit-transformed single-arm proportions and risk ratios (RRs) for direct comparisons. Risk of bias was assessed with design-specific tools and certainty with GRADE. The protocol was prospectively registered in PROSPERO (CRD420261436081).
RESULTS: Twenty-six core studies were included; 25 contributed to meta-analysis. Pooled proportions were 10.1% for wound infection (95% confidence interval [CI], 5.2%-18.7%), 8.1% for anal stenosis/stricture (95% CI, 5.1%-12.5%), 7.4% for rectal or mucosal prolapse (95% CI, 4.7%-11.4%), 3.4% for fistula recurrence (95% CI, 1.4%-8.2%), and 23.0% for constipation among age-eligible children (95% CI, 14.0%-35.3%). Single-stage repair was associated with more wound infection than staged repair (RR, 1.86; 95% CI, 1.10-3.16) and suggested more wound dehiscence/disruption (RR, 2.41; 95% CI, 1.00-5.83). Both comparisons were unadjusted and nonrandomized. No clear differences were found for anal stenosis, constipation, soiling, or voluntary bowel movements. Sensitivity analyses gave consistent results.
CONCLUSIONS: Single-stage repair was associated with a higher reported risk of wound infection, but this unadjusted, nonrandomized association is susceptible to confounding by indication and cannot establish causality; certainty was low. Evidence was insufficient to determine whether staging affects anal stenosis or age-eligible bowel outcomes. Decisions regarding fecal diversion should therefore remain individualized pending prospective comparative evidence.
PROSPERO: CRD420261436081.