Twenty years of experience with Y-V anoplasty for the treatment of minimal rectoperineal fistulas

Purpose: Y-V anoplasty, traditionally performed for anal stenosis, was applied to treat patients with imperforate anus with recto-perineal fistula located at the anterior margin of the external anal sphincter, defined as Minimal Recto-Perineal Fistula(MRPF). We present our 20-year experience using this approach in patients with MRPF, with a minimum follow-up of 5 years. Methods: This retrospective two-center study included patients who underwent Y-V anoplasty for MRPF between 2005 and 2020. The data collected included demographics, associated malformations, preoperative work-up, surgical details, postoperative management, complications, and long-term outcomes. Continence was evaluated using Rintala and Krickenbeck scores. Quality of life was assessed using the Incontinence-QoL score. Results: Thirty-nine children (20 females) were included. Associated malformations were present in 23% of cases. Median age at surgery was 1.8 months. All patients underwent short-term anal dilatations. No early complications occurred. Median follow-up was 10.1 years. One patient was lost to follow-up. No cases of anal stenosis or prolapse were observed. Constipation was detected in 26% (10/38) of patients and was conservatively managed in all cases. Median scores were QoL 10/10, Krickenbeck 7/7 and Rintala 19.5/20. Conclusion: Y-V anoplasty is a safe, reproducible, and sphincter-preserving technique. It is suitable for selected MRPF cases after careful anatomical assessment. Long-term functional and cosmetic outcomes are excellent.