Single-Stage Versus Staged Repair of Rectovestibular Fistula in Girls: A Systematic Review and Meta-analysis
In brief
Single-stage fistula repair nearly doubled wound infections in girls, but evidence is limited
In this review, wound infection was reported more often after single-stage than staged repair, with an estimated risk nearly twice as high. The comparison was unadjusted and nonrandomized, so it cannot show that the repair strategy caused the difference; rates of other key complications and bowel outcomes did not clearly differ, leaving diversion decisions individualized.
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 8 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Assylzhan M Messova, Makhmutbay Sanbayev, Arintay Alisher
- PMID
- 42849784
- DOI
- 10.1016/j.jpedsurg.2026.163525
Why clinicians should know about it
- Picked for Pediatric Surgery (top studies of the week, 11 October 2026): Systematic review/meta-analysis of single‑stage vs staged rectovestibular fistula repair
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.