Surgical Treatment of Rectovaginal Fistulas
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Rectovaginal fistulas account for less than 5% of all anorectal fistulas. They may occur as a result of obstetrical injuries, inflammatory bowel diseases, or pelvic cancer irradiation.The aim of the study was to describe the results of different methods of surgical treatment according to the etiology and localization of rectovaginal fistulas.Material and methods. The study included 23 female patients who underwent operations for rectovaginal fistulas within the period of 1995 to 2006. The age of patients ranged from 18 to 64 years, with an average age of 41 years.14 patients received radical treatment according to the etiology and localization of the fistulas: four were treated with abdominal approach, six with a local excision of the rectovaginal fistula involving layer closure of rectal and vaginal openings and interposition of musculomucosal flaps, and four with a simple fistulectomy involving the removal of inflamed tissue and the reconstruction of the perineal body, anal sphincters, and all layers of the rectal and vaginal walls.In nine cases, patients received a palliative surgical treatment to address extensive tissue destruction resulting from radiotherapy for uterine cervix cancer or advanced rectal cancer.Results. Complete recovery occurred in patients who underwent laparotomy for rectovaginal fistulas following inflammatory bowel disease or complicating anterior resection of the rectum. Patients operated on using rectal and vaginal approaches displayed positive results, as did those who underwent. fistulectomy with perineal body and anal sphincter reconstruction.Conclusions. Various surgical techniques are available for the management of rectovaginal fistulas depending on their etiology, size, and location. The best results of low rectovaginal fistula treatment occurred using fistulectomy with layer closure and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.
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27 - 11 - 2007
- Bernstein M: Rectovaginal fistula. In: John L. Cameron, ed.: Current Surgical Therapy. 6th ed., St. Louis, Mosby, 1998: 294-98.
- Antonsen HK, Kronborg O: Early complications after low anterior resection for rectal cancer using the EEA stapling device. Dis Colon Rectum 1987; 30: 379-83.
- Rex JC Jr, Khubchandani JT: Rectovaginal fistula: complication of low anterior resection. Dis Colon Rectum 1992; 35: 354-56.[PubMed][Crossref]
- Radcliff AG, Ritchie JK, Hawley MS et al.: Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 1988; 31: 94-99.[Crossref]
- Kumaran SS, Palanivelu C, Kavalakat AJ et al.: Laparoscopic repair of high rectovaginal fistula. Is it technically feasible? BMC Surgery 2005; 5: 20-26.[Crossref][PubMed]
- Casadeus D, Villasana L, Sanchez JM et al.: Treatment of rectovaginal fistula: A 5-year review. Aust NZJ Obst Gynecol 2006: 46: 49-51.
- Schwenk W, Bohm B, Grundel K et al.: Laparoscopic resection of rectovaginal fistula with intracorporeal colorectal anastomosis omentoplasty. Surg Endosc 1997; 11: 147-49.[PubMed][Crossref]
- Keighley MRB: Intestinal fistulas. In : Surgery of the anus, rectum and colon. Keighley MRB and Williams NS (eds). Sannders Co Ltd. London 1993; 2013-2102.
- Bannura GC, Contreras JP, Melo CL et al.: Espectro clinico de la fistula rectovaginal: analysis de 38 patientes. Rev Chil Obst Ginecol 2002; 67: 219-25.
- Cohen JL, Stricker JW, Schoetz DJJr et al.: Rectovaginal fistula in Crohn's disease. Dis Colon Rectum 1989; 32: 825-28.[PubMed][Crossref]
- Mazier WP, Senagore AJ, Schiesel EC: Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum 1995; 39: 4-6.[Crossref]
- Naru T, Rizvi JH, Talati J: Surgical repair of genital fistulae. J Obst Gynaecol Res 2004; 30: 293-96.[Crossref]
- Watson SJ, Phillips RKS: Non-inflammatory rectovaginal fistula. Br J Surg 1995; 82: 1641-43.
- Tsang CBS, Madoff RD, Wong WD: Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 1998; 41: 1141-46.[PubMed][Crossref]
- Willis S, Rau M, Schumpelick V: Surgical treatment of high anorectal and rectovaginal fistulas with the use of transanal endorectal advancement flaps. Chirurg 2000; 7: 836-40.[Crossref]
- Rahman MS, Al-Suleiman SA, El-Yahia AR et al.: Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 year's experience in a teaching hospital. J Obst Gynecol 2003; 23: 607-10.
- Wiskind AK, Thomson JD: Transverse transperineal repair of rectovaginal fistulas in the lower vagina. Am J Obst Gynecol 1992; 167: 694-95.
- Chew SSB, Rieger NA: Transperineal repair of obstetric-related anovaginal fistula. Aust NZJ Obst Gynecol 2004; 44: 68-71.
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