I found this case of Ano-vestibular Fistula in 30 year old female. The P/V examination reveals no extension and the patient has no previous H/O of any surgical treatment. What should be the course of treatment for this fistula? Should it be as for every fistula: follow/ drain through an anatomical structure?
Considering the fistula course (anterior), the patient gender and thinking about a possible future pregnancy I would do a LIFT procedure (ligation of the fistula tract in the intersphincterial space) adding a fistulotomy or a fistulectomy of the lateral tract (outside the external sphincter).
As second choice, if the fistula's tract is very superficial without significant involvement of the anal sphincters (withnormal anal tone) you could proceed with fistulotomy.
Ano-vestibular fistula is a congenital malformation. What you have depicted is simply fistula in ano. The terminology used to represent the pathology is incorrect. Thus the discussion is potentially misleading
If it is a congenital ano-vestibular, it will have an epithelial lining. If it is, then does it cause enough symptoms to warrant excision? In infants I would normally excise with a covering colostomy, but I know that in places where there is a lot more experience (India & China) it is often done without.
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