Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair

Kosugi, Chihiro; Saitô, Norio; Kimata, Yoshitaka; Ono, Masato; Sugito, Masanori; Ito, Masaaki; Sato, Kazunori; Koda, Keiji; Miyazaki, Masaru

doi:10.1016/j.surg.2004.10.004

Cited by 84 publications

(79 citation statements)

References 30 publications

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“…The reported incidence of rectovaginal fistulas following rectal excision is often low, 21 but findings comparable to the present study were recently reported by Kosugi et al 22 In the present trial, 6 of 7 patients with rectovaginal fistulas, initially not defunctioned, were reoperated with a laparotomy and a defunctioning stoma. This compares with the nondefunctioned patients with symptomatic leakage other than rectovaginal fistula of whom 22 of 26 were reoperated with a laparotomy and a stoma.…”

Section: Matthiessen Et Alsupporting

confidence: 89%

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Matthiessen

Hallböök²,

Rutegård³

et al. 2007

Annals of Surgery

973

327

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Objective: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not. Summary Background Data: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size. Methods: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival Ͼ6 months, informed consent, anastomosis Յ7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events. Results: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n ϭ 116) had leakage in 10.3% (12 of 116) and those without stoma (n ϭ 118) in 28.0% (33 of 118) (odds ratio ϭ 3.4; 95% confidence interval, 1.6 -6.9; P Ͻ 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P Ͻ 0.001). After a follow-up of median 42 months (range, 6 -72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups. Conclusion: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

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Section: Matthiessen Et Alsupporting

confidence: 89%

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Matthiessen

Hallböök²,

Rutegård³

et al. 2007

Annals of Surgery

973

327

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“…Retrovaginal fistulas occurred in 4.0 % of all patients, being in line with or somewhat lower than the 5.5-10 % rate previously reported [25,26]. A considerable number, 8 patients out of 11 with rectovaginal fistula, ended up with permanent stomas.…”

Section: Discussionsupporting

confidence: 72%

Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure

Räsänen

Renkonen–Sinisalo

Carpelan-Holmström³

et al. 2015

Int J Colorectal Dis

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“…Ein wichtiger Risikofaktor scheint die Verwendung von Klammernahtgeräten, v. a. in der Double-Stapling-Technik, zu sein [150,191,192,234,278,307]. Die häu-figste Ursache ist das versehentliche Miteinbringen der Vaginalwand in den Stapler, insbesondere nach vorausgegangener Hysterektomie [12,141].…”

Section: Rektovaginale Fisteln Nach Rektumresektionunclassified

“…Die therapeutischen Optionen bewegen sich zwischen der spontanen Abheilung unter Stomaschutz [150,204,234] über lokale Naht-und Flaptechniken [82,150] bis zur Aufhebung der Anastomose und Neuanlage, v. a. bei höher gelegenen Anastomosen [82,234].…”

Section: Rektovaginale Fisteln Nach Rektumresektionunclassified

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

Ommer¹,

Herold²,

Berg³

et al. 2012

coloproctology

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Rektovaginale Fisteln (RVF) sind definiert als mitEpithel ausgekleidete unnatürliche Verbindungen zwischen Rektum und Vagina. Die Häufigkeit wird mit etwa 5% aller anorektalen Fisteln angegeben [287]. Durch Abgang von Luft und Sekret bzw. Stuhl aus dem Rektum über die Scheide resultiert die psychosoziale Belastung der betroffenen Frauen. Diese nimmt mit dem Durchmesser der Fistel zu. Folgen können rezidivierende Entzündungen sowohl der Vagina als auch der unteren Harnwege sein. Bezüglich der Ätiologie müssen verschiedene Typen unterschieden werden. Ursachen stellen v. a. Entbindungstraumata und iatrogene Fisteln nach Eingriffen im Damm-und Becken bereich dar. Auch die Entstehung über lokale Entzündungen und Tumoren ist möglich. Ziel dieser S3-Leitlinie ist die Darstellung des Krankheitsbildes und der Therapieoptionen auf der Basis einer evidenzbasierten Aufarbeitung der vorhandenen Literatur.

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Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair

Cited by 84 publications

References 30 publications

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure

S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn)

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