Surgical Treatment of Rectovaginal Fistulas

Abstract

prof. dr hab. M. DrewsRectovaginal fistulas account for less than 5% of all anorectal fistulas. They may occur as a result of obstetrical injuries, inflammatory bowel diseases, or pelvic cancer irradiation. The aim of the study was to describe the results of different methods of surgical treatment according to the etiology and localization of rectovaginal fistulas. Material and methods. The study included 23 female patients who underwent operations for rectovaginal fistulas within the period of 1995 to 2006. The age of patients ranged from 18 to 64 years, with an average age of 41 years. 14 patients received radical treatment according to the etiology and localization of the fistulas: four were treated with abdominal approach, six with a local excision of the rectovaginal fistula involving layer closure of rectal and vaginal openings and interposition of musculomucosal flaps, and four with a simple fistulectomy involving the removal of inflamed tissue and the reconstruction of the perineal body, anal sphincters, and all layers of the rectal and vaginal walls. In nine cases, patients received a palliative surgical treatment to address extensive tissue destruction resulting from radiotherapy for uterine cervix cancer or advanced rectal cancer. Results. Complete recovery occurred in patients who underwent laparotomy for rectovaginal fistulas following inflammatory bowel disease or complicating anterior resection of the rectum. Patients operated on using rectal and vaginal approaches displayed positive results, as did those who underwent. fistulectomy with perineal body and anal sphincter reconstruction. Conclusions. Various surgical techniques are available for the management of rectovaginal fistulas depending on their etiology, size, and location. The best results of low rectovaginal fistula treatment occurred using fistulectomy with layer closure and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.

Martius Flap for Iatrogenic Rectovaginal Fistula: When to do a Diverting Stoma?

“…16,17 Koscinski and Sekowska offered their patients with low RVF and anal sphincter injury a combined approach of anal sphincter reconstruction plus advancement flap for repairing the RVF. 18 In this series, combining RVF surgery with anterior anal sphincter repair didn't add to the failure rate (0%). Instead, there was marked improvement of postoperative psychological status of patients as a consequence of enhanced continence.…”

Therapeutic options in radiation-induced rectovaginal fi stula

“…Niestety często okazuje się nieskuteczne i wymaga wdrożenia leczenia operacyjnego. W odniesieniu do popromiennych RVF metodą z wyboru pozostaje chirurgia (20) . Trzeba jednak pamiętać, że ze względu na obecność w polu operacyjnym napromienionych tkanek i upośledzonego ukrwienia technika zabiegu jest ekstremalnie trudna, przez co wymaga od operatora dużej sprawności i doświadczenia -często dochodzi do śródoperacyjnych trudności, kolejnych powikłań i nawrotów przetoki (12) .…”

“…Unfortunately, it often proves ineffective and requires the implementation of surgical treatment. For radiation-induced RVFs, surgery is the treatment of choice (20) . It should be noted, however, that it is extremely difficult due to the presence of irradiated tissues and impaired perfusion in the operating field, and therefore requires significant skills and experience from the operating surgeon; intraoperative difficulties, further complications and fistula recurrence are common (12) .…”