Transanal endoscopic microsurgical treatment of rectovaginal fistula: an original technique

Abstract

SummaryBackground: rectovaginal fistulas (RVFs) are a rare surgical condition. Their treatment is extremely difficult, and no standard surgical technique is accepted worldwide. This report describes a new approach using transanal endoscopic microsurgery (TEM) to treat RVFs. Materials and Methods: a retrospective review of 13 patients who underwent repair of rectovaginal fistula using TEM between 2001 and 2008 was undertaken. The surgical technique is widely described, and the advantages of the endorectal approach are well-known. Results: the median follow-up period was 25 months, and the median age of the patients was 44 years old (range, 25-70 years old). The mean operative time was 130 min (range, 90-150 min), and the hospital stay was 5 days (range, 3-8 days). One patient experienced recurrence. This patient underwent reoperation with TEM and experienced re-recurrence. Two patients had minor complications (hematoma of the septum and abscess of the septum), which were treated with medical therapy. For two patients, a moderate sphincter hypotonia was recorded.Discussion: a new technique for treating RVFs using TEM is presented. The authors strongly recommend this approach that avoids any incision of the perineal area, which is very painful and can damage sphincter functions.

Preventing Rectourethral Fistula Recurrence With Gracilis Flap

“…Management of RUF is especially difficult because of the high frequency of comorbidities and risk factors for poor wound healing such as history of cancer and radiation therapy. Rectourethral fistula repair has been reported with varying degree of success (62%–100%) with wide-ranging patient populations, follow-up length, and surgical approaches 8,14–16 . Our single-center retrospective study demonstrated a 92% success rate of RUF repair with gracilis flap, which falls in the higher end of the range of previously reported studies, including a meta-analysis of 416 patients who had surgical repair for RUF with an overall success rate of 87.5% 1 …”