Gracilis Muscle Interposition for Treatment of Complex Anal Fistula: Experience With 119 Consecutive Patients

Yellinek, Shlomo; Sousa, Cesar Barros; Gilshtein, Hayim; Strassmann, Victor; Silva, Giovana da; Wexner, Steven D.

doi:10.1097/dcr.0000000000001964

Cited by 9 publications

(18 citation statements)

References 14 publications

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“…The results show a primary healing rate of 33% and an overall healing rate of 65% when further intervention was indicated for final closure of the fistula. Similar results were obtained in previous studies [ 2 , 4 , 10 – 26 ]. Success rates in previous studies varied from 42 to 100% for primary healing by GMT alone and from 71 to 100% for overall healing (Table 5 ).…”

Section: Discussionsupporting

confidence: 93%

“…What almost all these studies have in common is the fact that a significant increase in the success rate was observed when further procedures were performed after GMT. This was shown particularly clearly in a recent study by Yellinek et al [ 26 ], which is also the largest series to date with a total of 119 patients. The percentage of successfully closed fistulas in the latter study increased from 42 to 92% after additional interventions.…”

Section: Discussionmentioning

confidence: 72%

“…The only solution is therefore complete and definitive closure of the fistula. The gracilis muscle has been used extensively in reconstructive surgery and has achieved good results in combating fistulas due to the well-perfused tissue it provides [ 2 , 4 , 10 – 26 ]. Overall healing rates range between 71 and 100% in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

Schoene

Schatz

Brunner

et al. 2023

Int J Colorectal Dis

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Purpose Complex fistulas often require several attempts at repair and continue to be a challenging task for the surgeon, but above all, a major burden for the affected patient. This study is aimed at evaluating the potential of gracilis muscle transposition (GMT) as a therapeutic option for complex fistulas of diverse etiologies. Methods A retrospective study was conducted over a period of 16 years with a total of 60 patients (mean age 50 years). All were treated for complex fistula with GMT at St. Josef’s Hospital in Regensburg, Germany. Follow-up data were collected and analyzed using a prospective database and telephone interview. Success was defined as the absence of fistula. Results A total of 60 patients (44 women, 16 men; mean age 50 years, range 24–82 years) were reviewed from January 2005 to June 2021. Primary fistula closure after GMT was achieved in 20 patients (33%) and 19 required further interventions for final healing. Overall healing rate was 65%. Fistula type was heterogeneous, with a dominant subgroup of 35 rectovaginal fistulas. Etiologies of the fistulas were irradiation, abscesses, obstetric injury, and iatrogenic/unknown, and 98% of patients had had previous unsuccessful repair attempts (mean 3.6, range 1–15). In 60% of patients with a stoma (all patients had a stoma, 60/60), stoma closure could be performed after successful fistula closure. Mean follow-up after surgery was 35.9 months (range 1–187 months). No severe intraoperative complications occurred. Postoperative complications were observed in 25%: wound healing disorders (n = 6), gracilis necroses (n = 3), incisional hernia (n = 2), scar tissue pain (n = 2), suture granuloma (n = 1), and osteomyelitis (n = 1). In 3 patients, a second gracilis transposition was performed due to fistula recurrence (n = 2) or fecal incontinence (n = 1). Conclusion Based on the authors’ experience, GMT is an effective therapeutic option for the treatment of complex fistulas when other therapeutic attempts have failed and should therefore be considered earlier in the treatment process. It should be seen as the main but not the only step, as additional procedures may be required for complete closure in some cases.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

Schoene

Schatz

Brunner

et al. 2023

Int J Colorectal Dis

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“…Out of the 16 studies including details on previous repairs, only 4 studies included patients in whom GMI was the first treatment. 28,32,37,40 The interval between RVF development and GMI ranged between 0 to 5 years.…”

Section: Resultsmentioning

confidence: 99%

Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis

Maspero

Piñeiro

Steele

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, which is the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulas, but literature on the subject is scarce, mainly consisting of small case series. OBJECTIVE: This study aimed to assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula. DATA SOURCES: MEDLINE, Embase, Cochrane Library, and Web of Science. STUDY SELECTION: Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions was applied. INTERVENTION: Gracilis muscle interposition. MAIN OUTCOME MEASURES: The primary outcome is the fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, and sexual function. RESULTS: Twenty studies were included for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53%–74%; range, 33%–100%). Risk factors for failure were smoking, underlying Crohn’s disease, and more than 2 previous repairs, whereas stoma formation was associated with improved outcomes. Postoperative complications ranged from 0% to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, but impairment of sexual function was common. LIMITATIONS: Most of the included studies were small case series. CONCLUSIONS: Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent rectovaginal fistula. REGISTRATION NO.: CRD42022319621.

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“…Apesar retovaginal com a simples derivação de trânsito é um evento incomum, mas também descrito em outras séries 61 . Fístulas retovaginais são de tratamento complexo e podem envolver retalhos regionais com índices de sucesso variáveis 62,63 , devendo ser indicado apenas para pacientes muito motivados e após período de tempo suficiente para determinar o prognóstico oncológico, apesar de não ter sido realizado em nenhum paciente desta série.…”

Section: Análise Estatísticaunclassified

Fatores de risco de colostomia definitiva em pacientes com carcinoma espinocelular anal derivados pré-quimiorradioterapia

Sobrado¹

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DedicatóriaAos pacientes, razão da medicina, sem os quais este estudo não teria sentido. Dedicatória v À minha mãe, Rosana Maria Novaes Faraco, pelo apoio incondicional, amor e carinho. Ao meu pai, Carlos Walter Sobrado Junior, pelo amor e companheirismo diário no exercício da profissão, pelo exemplo como médico e cirurgião. Aos meus irmãos, Marcel Faraco Sobrado e Flávia Faraco Sobrado, pelo carinho e amizade em todos os momentos da minha vida. Agradecimentos vi Agradecimentos Ao Prof. Sergio Carlos Nahas, pelo empenho na minha formação profissional e pessoal, pelo exemplo de dedicação e comprometimento com a disciplina de Coloproctologia e pelo estímulo constante nos estudos e na produção desta tese. Ao Professores Luiz Carneiro de Albuquerque e Ivan Cecconello, pela excelência na condução do Departamento de Gastroenterologia, pelo exemplo como líderes e pelos valiosos conselhos durante a minha formação como cirurgião. Ao Prof. Caio Sergio Rizkallah Nahas pelos ensinamentos durante a residência médica, pelo bom exemplo como médico e cirurgião, pelas orientações e sugestões sempre precisas na condução desta tese. Aos ilustres Professores e médicos associados da Disciplina de Coloproctologia do HCFMUSP que tive a honra de ter como mestres durante a minha formação:

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Gracilis Muscle Interposition for Treatment of Complex Anal Fistula: Experience With 119 Consecutive Patients

Cited by 9 publications

References 14 publications

Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis

Fatores de risco de colostomia definitiva em pacientes com carcinoma espinocelular anal derivados pré-quimiorradioterapia

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