Rectal Advancement Flap Repair of Rectourethral Fistula

Garofalo, Thomas E.; Delaney, Conor P.; Jones, Scott; Remzi, Feza H.; Fazio, Victor W.

doi:10.1007/s10350-004-6654-6

Cited by 84 publications

(51 citation statements)

References 33 publications

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“…However, under direct vision, dissection of the fistula sometimes is extremely difficult or impossible because of severe scar and broad diameter of the fistula [7]. To prevent refistulization, tissue flaps with vascular pedicel, such as omentum, gracilis muscle, or rectal wall have been interposed between the rectum and urethra or vagina [2,3,8], but these procedures were too complex to perform. Moreover, the hypertrophied and dilated colon was difficult to be pulled through the rectum using a posterior sagittal incision alone, such as case 1 and case 4.…”

Section: Discussionmentioning

confidence: 99%

“…Several kinds of approaches such as transanal approach, anterior perineal transanorectal approach and transanal endorectal pull-through, and vascularized tissue flap interposition have been described [1][2][3], but clinical data showed that recurrence of the fistula is always accompanied with anal stricture and severe scars around the fistula, the mobilization and repair of fistula may be extremely difficult through the above methods [4].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

et al. 2007

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Rectourethral or rectovaginal fistula is a troublesome complication after anorectal surgery. The pelvic and perineal dissection may be difficult because of severe fibrosis adhesion around the fistula. The authors applied a novel technique: a combined laparoscopic assisted abdominal and posterior sagittal approach (PSA) to perform the redo surgery. Three boys and two girls (3-13 years old): case 1 had rectovaginal fistula after rectal dialation and modified Swenson's procedure; case 2 had rectovestibular fistula after twice perineal anorectoplasty; case 3 had rectourethral fistula after twice anorectoplasty; case 4 was imperforate anus with Hirschsprung's disease and rectourethral fistula that had been misdiagnosed; case 5 had rectourethral fistula after abdominoperineoanoplasty and Mollard procedure and posterior sagittal anorectoplasty. Laparoscopic assisted abdominal dissection was done first to mobilize the colon as far as the mid pelvis, and the normal colon was marked with a suture. The lower pelvic dissection was performed through the posterior sagittal route, the proximal rectum was mobilized and servered, the distal rectum was left undisected, endorectal mucosectomy with electric ablation was performed, then the fistula was closed from inside the rectum, and the stump of the colon was pulled through the rectum, the stump and the dentate line were anastomosed extraanally. Colostomy was done in case 2 and case 5. The postoperative follow-up showed no recurrent fistula, and all patients had attained normal voluntary bowel actions, but one child had infrequent minor soiling. Laparoscopic assisted endorectal pull-through of the intact colon can offer precise dissection, minimal abdominal injure, and spare troublesome mobilization of the fistula, and can prevent the recurrent of fistula. Posterior sagittal approach provides a direct repair of the fistula and anastomosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

et al. 2007

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“…1 Conservative treatment consisting of urinary diversion, broad-spectrum antibiotics, and parenteral nutrition is often initially attempted. Success rates as high as 25-50% have been reported, [1][2][3] however, conservative treatments often fail. If the fistula remains open after 3-6 months, further healing is unlikely with continued conservative management, so further treatment for fistula closure is needed.…”

Section: Discussionmentioning

confidence: 97%

Pedicled vastus lateralis musculofascial flap as a new technique for repairing rectourethral fistula after radical prostatectomy

et al. 2011

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We present a case of successful operative management of an iatrogenic rectourethral fistula with a pedicled vastus lateralis musculofascial flap. The fistula was created during radical prostatectomy operation. During the operation, it was deemed possible to spare this patient from a diverting colostomy and primarily repair a rectal injury. Postoperatively, however, a rectourethral fistula occurred, which was confirmed on retrograde urethrogram. A first attempt failed to close the fistula utilizing the transanal rectal flap advancement technique. A novel technique was attempted using a pedicled vastus lateralis musculofascial flap. This is the first report to our knowledge of repairing a rectourethral fistula with a pedicled vastus lateralis musculofascial flap.

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“…A transanal or transperineal approach was used and all healed following 1 repair. Various surgical options are available to treat rectourethral fistula including transanal endorectal flap with or without biologic mesh reinforcement and transperineal repairs with the dartos or the gracilis interposition flap [3,8,[12][13][14][15][16][17][18][19][20][21][22]. Recently, advancement flap through a transanal endorectal microsurgery and closure after application of biologic glue have been described [23,24].…”

Section: Discussionmentioning

confidence: 99%

Rectourethral fistula following laparoscopic radical prostatectomy

Chun

Abbas

2011

Tech Coloproctol

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Rectal Advancement Flap Repair of Rectourethral Fistula

Abstract: The rectal advancement flap provides an effective repair for rectourethral fistula. Successful repair can be achieved in a majority of patients with minimal morbidity, short length of stay, and a good postoperative quality of life.

Cited by 84 publications

References 33 publications

Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula

Pedicled vastus lateralis musculofascial flap as a new technique for repairing rectourethral fistula after radical prostatectomy

Rectourethral fistula following laparoscopic radical prostatectomy

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