Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition

Abstract

INTRODUCTIONRectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures.PRESENTATION OF CASEWe report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures.DISCUSSIONThis technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum.CONCLUSIONIn our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair.

Rectovaginal Fistula with Anastomotic Stricture Post Anterior Resection – Sphincter Preservation, a Viable Option

“…Approach for local repair may be endorectal, trans vaginal or trans perineal. Various tissue options available for interposition include omental flap, gracilis flap, adipose tissue from labia majora [7], bulbocavernosus [8], pubococygeus [9] and gracilis muscle [10]. Direct local repair though attractive because of its minimally invasive nature is often unsuccessful since anovaginal septum is a thin, poorly vascularized structure with successful healing reported in 66.7 % cases [6].…”