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Surgical Treatment of Rectovaginal Fistulas

100%
Kościński T., Sękowska M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
533-539
EN
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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Restorative Proctocolectomy for Emergency Cases of Ulcerative Colitis

81%
Hermann J., Sękowska M., Drews M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 4
265-268
EN
Restorative proctocolectomy was performed for urgent indications in three stages and for elective purposes in two stages for ulcerative colitis (UC). Since the three-step procedure makes enormous demands on the patients, there was an attempt to introduce a primary pouch anal anastomosis for urgent indications in selected cases.The aim of the study was to compare early complications in patients after having undergone Hartmann's procedure with those that had restorative proctocolectomy for urgent indications in UC, based on the authors' experience and the literature.Material and methods. The medical records of 211 patients who underwent an operation for UC in this clinic from 1996 through 2005 were retrospectively evaluated. There were 107 (51%) males and 104 (49%) females in this study; the mean age was 38 years. The median duration of disease was 3 years.Results. An operation was performed in 77 (36%) patients for urgent indications. Finally, the study was entered by 60 (28%) patients after exclusion of the high-risk patients. All the patients were divided into two groups. The first group consisted of 25 (42%) patients who underwent the Hartmann's procedure, whereas the second group comprised 35 (58%) patients who had the pouch operation. There was no postoperative mortality in the surveyed group. Respiratory failure occurred in 6 (24%) patients after Hartmann's operation and in 5 (14%) patients who underwent the pouch procedure. Intra-abdominal sepsis developed in 3 (12%) patients after colectomy and in 5 (14%) after pouch-anal anastomosis. Wound dehiscence was present in 2 (8%) patients undergoing Hartmann's operation and in 3 (9%) after the pouch procedure. Bowel obstruction occurred in 1 patient after the former operation and in 2 (6%) patients after the latter one. Wound infection was diagnosed in 5 (20%) patients after colectomy and in 7 (20%) after proctocolectomy. Differences between the investigated groups of patients were not statistically significant.Results. The three-stage procedure with Hartmann's colectomy is the treatment of choice for urgent indications in UC.Primary restorative proctocolectomy is performed for urgent indications in acute UC in selected group of patients without septic signs due to a similar morbidity as the group of patients who had Hartmann's procedure.
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Treatment of the Hemorrhoids and Anal Mucosal Prolapse Using Elastic Band Ligature - Early and Long Term Results

71%
Sękowska M., Kościński T., Wierzbicki T., Hermann J., Drews M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
654-661
EN
The aim of the study was to evaluate the results of the treatment of internal hemorrhoids and anal mucosal prolapse using elastic band ligation and to compare this method to chosen surgical procedures.Material and methods. The study included 648 patients (363 males and 285 females). 474 patients were treated using an elastic band ligature and 174 patients underwent surgical hemorrhoidectomy. The average age of the patients in both groups was similar - 49 years.The treatment tolerance was evaluated in the prospective study group. The intensity and duration of pain was assessed on the first and second postoperative day using a Verbal Rating Scale.Results. 86.5% of the patients were cured using Barron's procedure, success rate for second-degree hemorrhoids was 89% and for third degree - 85.2%. Surgical hemorrhoidectomy was effective in 92% of patients. Early failure of elastic ligature was noted in 2.5% of patients. The recurrences of hemorrhoidal symptoms were observed in 11% of Barron's group and in 8% after hemorrhoidectomy. The intensity of pain was much higher among patients after surgical hemorrhoidectomy. The average of the pain score in the 4th hour was 0.3 for the elastic band ligation and 1.4 for the surgical treatment. In the 24th hour - 0.2 and 1.7 respectively. Mean postoperative stay was 3.8 days.Conclusions. Rubber band ligation is highly effective and well tolerated. Relatively minor pain following this procedure is found in only 9.5% of patients. The disadvantages of surgical hemorrhoidectomy are: important postoperative pain and long time of wound healing that impair the recovery to professional activity.
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