Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases

Abstract

Introduction: Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique. Methods: We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications. Outcomes: RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2–3 months. Both patients showed excellent wound healing and physiological function. Conclusions: The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.

Risk Factors for Intrapartum Anorectal Mucosal Lacerations and Rectovaginal Fistula: A Retrospective Comparative Study

“…Eventually, 3 cases were spontaneously repaired, and 2 cases were cured by repair surgery. For the repair of anorectal mucosal lacerations, a combination of a horizontal mattress suture and running suture has been reported to be useful without complications (6) , (11) . Although the suture method may be amenable to symmetrical anorectal lacerations following midline episiotomy, irregular lacerations that are unevenly stretched after mediolateral episiotomy cannot be sutured typically.…”

“…The situation may also be related to the cause of the failed primary repair. If the sutures are not evenly pressurized, vulnerable areas will occur at the sutures, and if the blood flow is not sufficient, prolonged ischemia, infection, and necrosis will be more likely to occur (6) , (11) , (12) . Uneven pressure from fecal masses can also lead to the formation of a fistula in the vulnerable areas of the sutures.…”