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Differentiated surgical treatment of rectovaginal fistulae

By Feride Kröpil, Andreas M. Raffel, Matthias Schauer, Alexander Rehders, Claus F. Eisenberger and Wolfram T. Knoefel

Abstract

Objective: Rectovaginal fistulae (RVF) are a serious and debilitating problem for patients and a challenge for the treating surgeons. We present our experiences in the surgical treatment of these patients. \ud \ud Methods: Study population consisted of 22 consecutive patients (range 26–70 years) with RVF treated in our department between 2003 and 2009. 13 RVF were observed after colorectal or gynaecological surgery, 3 occurred after radiotherapy, 2 due to tumour infiltration, 4 because of local inflammation (3x diverticultis, 1x ulcus simplex recti). The RVF was classified in all patients before treatment as either ‘low’ or ‘high’. \ud \ud Results: Local procedures (transvaginal excision, preanal repair) as initial treatment were performed in 9 patients with low fistula. In 13 cases with high fistula an abdominal approach was performed to close the fistula. A recurrence was observed in 8/22 cases (36%), which were treated by a gracilis flap (n=2), a bulbospongiosus composite (n=1), a second abdominal approach (n=4), and a re-local excision (n=1). Ultimatively, in 19 cases the defect healed but in 3 patients the RVF persisted. \ud \ud Conclusions: Most important predictor of healing/failure is etiology followed by localization and recurrence of the RVF. Local (preanal, transvaginal) procedures are suitable for low RVF, whereas abdominal surgery is necessary in high RVF. In recurrent RVF, muscle flaps are promising procedures

Topics: rectovaginal fistula, preanal repair, gracilis flap, recurrence, Medicine, R, Surgery, RD1-811
Publisher: German Medical Science GMS Publishing House
Year: 2012
DOI identifier: 10.3205/iprs000010
OAI identifier: oai:doaj.org/article:e610bc3557a54295b5f4cf96083e81a2
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