Gracilis Muscle Transposition for Fistulas Between the Rectum and Urethra or Vagina

Zmora, Osnat; Tulchinsky, Hagit; Gur, Eyal; Goldman, Gideon; Klausner, Joseph M.; Rabau, Micha

doi:10.1007/s10350-006-0585-3

Cited by 136 publications

(76 citation statements)

References 20 publications

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“…Successful use of the gracilis muscle interposition has been reported for Crohn's RVF repairs, especially after other failed repairs. Zmora et al [38] reported on their use of the gracilis flap in nine patients for various causes of fistula, including 3 rectourethral fistulae, 1 pouchvaginal fistula, and 5 RVF (2 CD associated RVF). All patients underwent fecal diversion.…”

Section: Miscellaneous Repairsmentioning

confidence: 99%

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Valente

Hull

2014

WJGP

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Rectovaginal fistula is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Rectovaginal fistula; Crohn's disease; Fistula; Advancement flap; Sleeve advancement; Episioproctotomy Core tip: Rectovaginal fistula secondary to Crohn's disease is a devastating and disabling condition with a significant negative impact on quality of life. Furthermore, these fistulae pose an extremely challenging dilemma for the clinician with unique and often frustrating management challenges. Medical management is often futile and surgery may offer the only chance for cure. In this article, we aim to review the various treatment options to close these difficult to treat fistulae, with an emphasis on surgical technique and complex decision making. INTRODUCTIONFistula-in-ano is the most common perianal manifestation of Crohn's disease (CD) and was first reported by Gabriel [1] in 1921, nine years before Crohn et al [2] identified regional enteritis as a clinical entity. These fistulae are classified by their relationship to the sphincter complex as either high (supra-or extra-sphincteric vs low (inter-or trans-sphincteric). Low fistulae that transverse the anal sphincter are more appropriately named anovaginal fistulae, but by convention, all such fistulae are termed rectovaginal fistula (RVF). After obstetrical trauma, CD is the most common etiological factor for RVF, and will occur in up to 10% of women with CD [3,4] . Rectovaginal fistulae secondary to CD are associated with significant morbidity and carry an increased risk for proctectomy [5,6] . It is a devastating and disabling condition and is a source of considerable social embarrassment Contemporary surgical management of rectovaginal fistula in Crohn's diseaseMichael A Valente, Tracy L Hull and has a significant negative impact on quality of life. Furthermore, CD associated RVF are an extremely challenging dilemma for the clinician and present unique and often frustrating management challenges. In this article, we aim to review the various treatment options to close these difficult to treat fistulae, with an emphasis on surgical technique and decision making. PRESENTATION AND DIAGNOSISThe presence of a fis...

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Section: Miscellaneous Repairsmentioning

confidence: 99%

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Valente

Hull

2014

WJGP

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“…Other studies have not demonstrated any advantage of a diverting stoma [6,[14][15][16]. Some have suggested that the interposition of a gracilis flap may avoid the need for a permanent ileostomy in patients with recurrent pouchvaginal fistulae [17,18]. In our series, temporary diversion was used in all patients and it may have contributed to the high healing rate even in some recurrent fistulae.…”

Section: Discussionmentioning

confidence: 59%

Complex Rectovaginal Fistula—an Experience at a Tertiary Care Centre

et al. 2015

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Complex rectovaginal fistulae are difficult to manage. With an initial failed attempt, a simple fistula becomes complex and the success rate of a subsequent repair decreases. A review of our prospectively maintained records over a period of 16 years revealed 25 patients with rectovaginal fistulae. A variety of procedures was performed in these patients according to their aetiology, site and if there had been a previous attempt at repair. The mean age of the patients was 45 years. The most common cause was operative trauma in 14 cases. Ten patients had previous attempts at repair which had not been successful. The surgical procedures we performed included re-enforcement flaps, resection with diversion, repair with re-enforcement with omentum and simple diversion. Two patients developed recurrence, and one of them healed after a second repair. No recurrence developed in 10 patients who had failed attempts at repair elsewhere. Our experience has shown that most complex rectovaginal fistulae can be successfully repaired but they might require repeated operations. Faecal diversion is usually necessary, and in recurrent fistulae, we found that rather than a local repair, a muscle flap or omental interposition improves the chances of healing.

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“…Zmora et al noted that three of nine patients with graciloplasty for rectovaginal and urethral fistulas had postoperative minor wound sepsis with no other short or long-term complications. 10 In a review of the literature since 1980, Penninckx et al 5 compared healing rates after various surgical procedures for RVF. They concluded that all types of repair seemed to be equally effective.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7]10,17 In these series (including an overall rate of only 25%), the overall healing rate after GMT was 84% (21/25) after a mean follow-up of 2 years. The present study, with a median follow-up of 28 months after stoma closure, compares favorably with a success rate of 88%.…”

Section: Discussionmentioning

confidence: 99%