Minimally invasive treatment of rectovaginal fistula

Abstract

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.

Endoscopic placement of self-expandable metallic stents for rectovaginal fistula after colorectal resection: a comparison with proximal diverting ileostomy alone

“…Results are less satisfactory in case of Crohn disease or infection, with a recurrence rate of 50 %, and the possibility of residual incontinence after the fistula has healed [11,12].…”

“…In higher fistulae, an abdominal approach is preferred. In recurrent rectovaginal fistulae, autologus tissue (gracilis muscle or a labium major) or biologically degradable materials are interposed between the vagina and the rectal wall [3][4][5][6][7][11][12][13][14][15].…”

Transanal Endoscopic Microsurgery

“…However TEM has recently become a more attractive option because of the regular use of neoadjuvant therapy at several centers [4,5,[8][9][10][11][12][13]. Still other indications have also been described: repair of high or supralevator fistulas, rectourethral fistulas and rectal prolapse, drainage of pelvic collections, impacted fecaloma and excision of extra rectal masses [5,[14][15][16]. The aim of this study is a report on the introduction of a national program of advanced surgical technology at the National Center for Minimally Invasive Surgery in Havana, Cuba.…”

Transanal endoscopic surgery: patient selection and perspectives

“…2 Other uses for TES TES is most often used for benign and malignant rectal neoplasia; however, many surgeons have attempted to use TES to treat other colorectal diseases, including but not limited to rectovaginal fistula (RVF), RUF, stricture, and anastomotic leak. A review by D'Ambrosio et al 37 looked at the use of TES for the repair of RVF using the rigid TEM platform in 13 reported cases. Using a combination of TES and manual dissection, a layered closure was performed thus sparing patients from a perineal incision.…”

“…Despite this, results have shown an overall healing rate of 93%, with minor complications in15%. 37 In addition, Darwood and Borley 38 described using TES for high RVF using a mucosal advancement flap, stating excellent visualization and low morbidity. 38 A similar approach has been used for repair of RUF.…”