Surgical management of recto-vaginal fistula (about 6 cases)

Abstract

Introduction Recto-vaginal fistula (RVF) is defined as a pathological epithelialized communication between the posterior wall of the vagina and the anterior wall of the rectum through the recto-vaginal septum. RVFs are rare and represent less than 5% of rectal fistulas. Occurring after childbirth or during a proctological pathology, they create a deep distress for the patients. The aim of our work is to analyze the epidemiological particularities and the risk factors of occurrence of RVF as well as the modalities and results of our therapeutic management. Materials and methods Our work is retrospective analytic and comparative concerning 6 cases operated in the department of general surgery 3 of the UHC Ibn Rochd of Casablanca for recto vaginal fistula or recidive over a period of 7 years from 2012 to 2018. Results The analysis of the results of our study allowed us to note: A frequency of occurrence of RVF of about 0.48%. The average age at diagnosis was 55 in our patients. The etiologies were dominated by post-radiation (33.33%) and post-operative (16.66%) RVFs. The predominant mode of delivery in our study was vaginal delivery (83.33%). The antecedents were dominated by pelvic irradiation in 50% of patients, and pelvic surgery for cervical cancer and/or rectal cancer (50%). The diagnosis was revealed by a vaginal stool output in all patients. Surgical treatment was performed in all our patients. The surgical technique of choice in our series was drainage by Stenon, in 83.33% of patients. A protective stoma was performed in all our patients studied, a colostomy in 66.66%, and an ileostomy in 33.33% of patients. The immediate postoperative evolution was excellent in all our patients, while the short- and medium-term evolution revealed the occurrence of recurrence in one third of the patients (33.33%). The treatment of choice for recurrence was the interposition of a pedicled fat flap of the labia majora, known as the modified Martius technique. The morbidity, represented mainly by recurrence, was 25%, with a mortality rate of 0%. Discussion The occurrence of RVF in all its etiologies seems to be infrequent. However, its real incidence remains poorly documented in the literature, it varies between 0.3% and 15.3%. RVFs are considered simple or complex depending on their size, location and etiology. The high or low location and the etiology of the RVF determine the choice of the approach during surgical management. The diagnosis is most often clinical. The examination will try to find the cause of the RVF and the associated lesions. RVF can be asymptomatic. The importance of the symptoms depends on the topography of the fistula, the diameter of the orifice, and the quality of the intestinal transit. No additional investigations are required to confirm the diagnosis of RVF, since the positive diagnosis is essentially clinical. However, in the case of a high or complex fistula, the clinician can support his or her...

Two Decadal Experiences in Managing Combined Obstetric Vesicovaginal and Rectovaginal Fistulas: A Study From Northern Indian Tertiary Hospital

“…In an interesting and landmark study, Reisenauer reported on the transvaginal closure of the rectovaginal fistula with a success rate of 92.4% [16]. Transvaginal repair of VVF and RVF with an interposition flap has shown excellent results [12][13][14]19,21,22].…”

“…The transvaginal repair of vesicovaginal and rectovaginal fistulas, either in one sitting (single operation) or two different operative sessions (staged repair), can be done with Martius flap interposition. The association of VVF with RVF is categorised as complicated VVF, and the success rate for VVF repair in such cases has been reported at more than 86% [ 12 , 13 ]. Apart from the Martius vascular pedicle flap, the gracilis muscle can also be used as an interposition flap [ 14 ].…”

Modern opportunities for treatment of patients with rectovaginal fistulas: literature review

“…Ректовагинальные свищи классифицируются в зависимости от их расположения, размера и этиологии как простые или сложные свищи [1,23]. Классификация местоположения имеет важное значение, т. к. она определяет план лечения, поскольку свищ низкого типа может быть устранен с помощью местных или промежностных хирургических вмешательств, в то время как трансабдоминальный доступ обычно требуется для свищей высокого типа.…”

“…Ректовагинальный свищ (РВС) -патологическое эпителизированное сообщение между задней стенкой влагалища и передней стенкой прямой кишки через ректовагинальную перегородку [1].…”

“…Ректовагинальные свищи составляют менее 5% всех свищей прямой кишки, но приводят не только к физическим страданиям, включая воспаление и раздражение, но и к эмоциональному дискомфорту, социальной и сексуальной дисфункции [1,2]. Родовая травма является наиболее распространенной причиной РВС, на долю которой приходится 60-80%.…”