Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty

Khanduja, K. S.; Padmanabhan, Anantha; Kerner, Bruce; Wise, William E.; Aguilar, Pedro Serrano

doi:10.1007/bf02235043

Cited by 59 publications

(24 citation statements)

References 17 publications

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“…This can be accomplished with either a rectal advancement flap performed in concurrence with an anterior sphincteroplasty [31] or as the case at our institution, an episioproctotomy is performed [32] . An episioproctotomy entails performing a fistulotomy and creating of a defect similar to a fourth degree perineal laceration during vaginal childbirth [32] .…”

Section: Transperineal Approachesmentioning

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: Transperineal Approachesmentioning

confidence: 99%

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Valente

Hull

2014

WJGP

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“…Success rates have ranged from 74 to 95 % [ 37 , 64 -66 ]. In a series where all 20 patients had mucosal fl aps in addition to sphincteroplasties, Khanduja et al reported that drainage of stool and fl atus stopped in all, and 14 had perfect continence while six reported their continence was improved [ 67 ].…”

Section: Rectovaginal Fistulamentioning

confidence: 99%

Endorectal Advancement Flap

Jensen

2013

Anal Fistula

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“…Sphincteroplasty can, in many cases, be done in conjunction with fistula repair (e.g., a high rectal vaginal fistula after a fourth-degree tear) [43]. Here, the sphincter repair will act as a "buttress" to help facilitate healing of the fistula.…”

Section: Sphincteroplastymentioning

confidence: 99%