If the rectal mucosa is generally normal, high rectal stula without active proctitis or compli­cated Crohn’s disease can be covered by mucous membrane ap metastasis. The key to successful surgery includes that the mucosal ap should include the mucosa, submucosa, and part of the internal sphincter and should be at least 1/4 of the total width of the rectum to ensure adequate blood supply. The length of the free ap should be longer than that of the anal stula so as to ensure the tension-free suture after the internal mouth resection and debridement. Hemostasis must be carefully stopped during the operation. In complete stula debridement or resection, ade­quate drainage should be maintained by proper expansion of the external orice. The short-term cure rate is 64–75%. The short-term cure rate of Crohn’s disease complicated by rectovaginal s­tula is 40–50%. The recurrence rate was posi­tively correlated with follow-up time. Patients who fail surgical treatment can be reoperated on. The success rate of prolapse mucous ap/ap repair in the treatment of CD anal stula is closely related to intestinal inammation, and the prognosis is poor when there is active rectal inammation. The presence of rectal inamma­tion is a major factor in the failure of the opera­tion. When there is rectal inammation, suture drainage should be used, and the operation can only be accepted after the inammation is controlled.

It is worth pointing out that some scholars in China have afrmed speculative aspects when citing foreign literature reports. As a result, the domestic anorectal community generally believes that infantile anal stula is related to male hor­mones and is related to male hormones stimulat­ing anal gland secretion. Studies have shown that (1) whether it is a baby boy or a baby girl, the level of sex hormones increases within 1 year after birth. In neonates, within 1 year of age, especially in newborns to 3 months, the negative feedback inhibition caused by the high concen­tration of sex hormones from the mother is no longer present, so the baby’s own sex hormone secretion suddenly increases, reaching or even surpassing normal adult levels. These hormones include estradiol, progesterone, pituitary prolac­tin, etc. Some infants may even display galactor­rhea, and there are signicant differences compared with other age groups. After this, due to the gradual enhancement of the central ner­vous system’s control ability, the hypothalamic– pituitary–gonadal axis is controlled by the negative feedback of sex hormones, so the level of sex hormones in the body rapidly decreases, in addition to PRL by the age of 1–3 years old. At the lowest level, the effect of this negative feed­back can continue until puberty. (2) The male hormone content in male infants after birth to 3 years old is signicantly lower than that of males aged 9–15 years, the former being 0.27 ± 0.31 and the latter being 0.38± 0.55. However, 9–15 years old is obviously not the peak incidence of anal stula in infants and young children. (3) The multiple hormone levels of male infants (not just androgen, but also female hormones) are higher than those of female infants. Progesterone (P), testosterone (T), and pituitary prolactin (PRL) values were signicantly different from those of females (P<0.05). In the later growth and devel­opment process, the gender difference is more and more obvious. After entering puberty, the estrogens such as E2, P, and PRL in male chil­dren are decreasing year by year, and androgens and gonadotropins such as T, FSH, and LH are rising year by year, especially with T rising most signicantly. At the age of 1 and 3 years of age, females are less affected by maternal sex hor-