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 the complications and outcomes following PRAA.

A retrospective, single-institution study was performed of female patients with an anorectal malformation with a rectoperineal fistula between January 2020 and December 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 and complications.

Twelve patients underwent PRAA at a median age of 171 days with a 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 1. On follow-up, all patients were stooling spontaneously, and nine (75%) were utilizing daily laxatives.

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 1 postoperative day. It can be done without the need for a colostomy. Longer-term data are needed to continue to explore functional outcomes.

Received: 12 July 2025

Accepted: 10 December 2025

Accepted Manuscript online:
15 December 2025

Article published online:
06 January 2026

© 2026. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany