Stromal vascular fraction injection to treat intractable radiation-induced rectovaginal fistula

Kim, Mi Jung; Lew, Dae Hyun; Roh, Tai Suk; Song, Seung Yong

doi:10.5999/aps.2020.01718

Cited by 1 publication

(2 citation statements)

References 15 publications

(14 reference statements)

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“…It could be a combined colostomy and interposition fl ap as the modifi ed Martius graft with advantage. However, there are described preliminarily good results after the stromal vascular fraction injection to surroundings of radiationinduced RVF (11).…”

Section: Discussionmentioning

confidence: 99%

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Modified Martius graft – a renaissance of surgical procedure

Dobrovodsky¹,

Pechan²,

Duffek³

et al. 2022

BLL

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AIM: The rectovaginal fi stula (RVF) is relatively uncommon and by clinical manifestations grave illness. The surgery treatment of RVF is extremely demanding and represents the subject of frustration for many surgeons. Miscellaneous etiology of RVF and various heights of fi stula in a rectovaginal septum are crucial for the choice of surgical procedure. Despite targeted treatment, more than one-half of rectovaginal fi stulas recurs. We evaluated the frequency of recurrences after surgical treatment by modifi ed Martius graft and its infl uence on continence and quality of life. The necessity of concomitant colostomy when performing modifi ed Martius graft was the secondary aim. METHOD: We collected and analyzed 8 years of data from our patient database. There were admitted 21 female patients with diagnosis RVF to the Surgery department of Faculty Hospital Trnava. Unfortunately, only 5 patients, concerning the etiology of disease and clinical state, were indicated for surgery by modifi ed Martius graft. All RVFs were low and a defect in the rectovaginal septum wouldn't exceed 1.5 cm in diameter. RESULTS: Due to the small sample and non-confi rmation of normality in all variables, nonparametric comparison tests were chosen for paired samples differences. We used the Wilcoxon sign-rank test and counted the effect sizes expressed the success of the treatment. Each female patient with low RVF included in this study has healed. The mean value of a complete healing of RVF in our cohort was 12 weeks. We had discovered one recurrence after surgery, that was successfully repaired by contralateral modifi ed Martius graft. The signifi cant decrease of Wexner fecal incontinence score in the observed group (p < 0.05, r = 0.639) and slightly elevated Cleveland Clinic Constipation Scoring System (p < 0.05, r = -0.577) were confi rmed. The protective colostomy was performed just once. Only two sections of the SF-36 Health Survey -the physical functioning and the bodily pain, were without signifi cant changes. The rest of the watching sections of SF-36 have changed signifi cantly. CONCLUSION: Treatment of low rectovaginal fi stulas (LRVF) by modifi ed Martius graft is followed by a low percentage of recurrences. It should be the fi rst-line therapy in the algorithm of surgical treatment of LRVF, without the necessity of protective colostomy (Tab. 2, Fig. 3, Ref. 27).

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Section: Discussionmentioning

confidence: 99%

“…There are quite good results with stem cells application in Crohn's RVFs too (10). Likewise, the injection of stromal vascular fraction derived from adipose tissue to surroundings of local fl ap covering fi stula opening is a promising treatment modality of the radiation-induced RVF (11).…”

Section: Introductionmentioning

confidence: 99%