The treatment for refractory rectovaginal fistula after low anterior resection with estriol, polyglycolic acid sheets and primary closure: A case report

Hiraki, Masatsugu; Tanaka, Toshiya; Kanai, Tadayuki; Shimamura, Takuya; Ikeda, Osamu; Yasunaga, Makio; Ogata, Shinichi; Kono, Kenji

doi:10.1016/j.ijscr.2020.09.118

Cited by 3 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these healed cases were reported only as case reports [42,43]. The documented case reports in using vaginal or oral estriol tablet in addition to conservative therapy resulted in the closure of RVFs [44][45][46]. Summarizing the successful case reports after LAR, vaginal estriol tablet was given in eight patients without surgical intervention, and six of eight RVFs healed within 35 days.…”

Section: Rvfs After Low-anterior Resection (Lar)mentioning

confidence: 99%

Treatment of Rectovaginal Fistula

Maeda

Wada

Shida

2023

J Anus Rectum Colon

View full text Add to dashboard Cite

Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. With insufficient clinical data due to the rare entity, the present state of treatments for RVFs was reviewed especially form the point of factors to determine management, classifications, principle of treatment, conservative and surgical treatments with outcomes. Size, fistula localization and etiology, type of fistula; “simple” or “complex,” status of anal sphincter complex and surrounding tissue, presence or absence of inflammation, presence of diverting stoma, previous attempted repair and radiation therapy, patient's condition with co-morbidities, and surgeon's experience are important factors to determine the management of RVF. The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period. Anal sphincter damage might need a repair of sphincter muscles along with RVF repair. Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient's pain. Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs.

show abstract

Section: Rvfs After Low-anterior Resection (Lar)mentioning

confidence: 99%

Treatment of Rectovaginal Fistula

Maeda

Wada

Shida

2023

J Anus Rectum Colon

View full text Add to dashboard Cite

show abstract

“…Notably, the diameter of the RVF with spontaneous healing reported in the literature was not larger than 1 cm. Some investigators have suggested giving concentrated coagulation factor XIII intravenously for 5 d during nonoperative treatment to promote fistula healing because this coagulation factor is decreased significantly in the early postoperative period and may interfere with wound healing[ 14 , 17 ]. A large survey of active members of the American Society of Colon and Rectal Surgeons in the 1990s identified a total of 57 RVF after low anterior resection, and 14 of them were managed conservatively.…”

Section: Managementmentioning

confidence: 99%

“…However, some of the patients receiving the endoscopic placement of self-expandable metal stents experienced stent dislodgement or severe tenesmus requiring stent removal. Other endoluminal interventions for treating RVF after low anterior resection reported in the literature include fibrin glue application[ 22 ], fistula coverage with polyglycolic acid sheet[ 17 ], endoluminal clipping[ 23 , 24 ], and transanal endoscopic suturing[ 25 ].…”

Section: Managementmentioning

confidence: 99%

Rectovaginal fistula after low anterior resection: Prevention and management

Lohsiriwat¹,

Jitmungngan²

2021

WJGS

View full text Add to dashboard Cite

Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. This problematic complication could lead to multiple operations, stoma formation, sexual dysfunction, fecal incontinence and psychosocial ramifications. This review comprehensively covers an overview of its incidence, risk factors, presentation and evaluation, management (ranging from conservative measures, endoscopic treatment and local tissue repair to radical resection and redo anastomosis) and treatment outcomes of rectovaginal fistula after low anterior resection. Notably, these therapeutic options and outcomes are influenced by several factors, including the size and location of the fistula, tumor clearance, cancer staging, quality of colorectal anastomosis and surrounding tissue, presence of diverting stoma, previous attempted repair, and the surgeon’s experience. Also, strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations. Finally, a decision-making algorithm for managing this complication is proposed.

show abstract

Postoperative rectovaginal fistula: stoma may not be necessary—a French retrospective cohort

Poitevin,

Hamel,

Ngoma

et al. 2024

Tech Coloproctol

View full text Add to dashboard Cite

Background Postoperative rectovaginal fistula leads to a loss of patients’ quality of life and presents significant challenges to the surgeon. The literature focusing specifically on postoperative rectovaginal fistulas is limited. The objective of the present study is to identify factors that can enhance the success of the management of this postoperative rectovaginal fistula. Methods This retrospective multicentric study included all patients undergoing surgery for rectovaginal fistulas, excluding those for whom the etiology of rectovaginal fistula was not postoperative. The major outcome measure was the success of the procedure. Results A total of 82 patients with postsurgical fistulas were identified, of whom 70 were successfully treated, giving a success rate of 85.4%. On average, these patients required 3.04 ± 2.72 interventions. The creation of a diversion stoma did not increase the success rate of management [odds ratio (OR) = 0.488; 95% confidence interval (CI) 0.107–2.220]. Among the 217 procedures performed, 69 were successful, accounting for a 31.8% success rate. The number of interventions and the creation of a diversion stoma did not correlate with the success of management. However, direct coloanal anastomosis was significantly associated with success (OR = 35.06; 95% CI 1.271–997.603; p = 0.036) as compared with endorectal advancement flap (ERAF). Other procedures such as Martius flap did not show a significantly higher success rate. Conclusion The creation of a diversion stoma is not necessary in closing a fistula. ERAF should be considered as a first-line treatment prior to proposing more invasive approach such as direct coloanal anastomosis.

show abstract

The treatment for refractory rectovaginal fistula after low anterior resection with estriol, polyglycolic acid sheets and primary closure: A case report

Cited by 3 publications

References 15 publications

Treatment of Rectovaginal Fistula

Treatment of Rectovaginal Fistula

Rectovaginal fistula after low anterior resection: Prevention and management

Postoperative rectovaginal fistula: stoma may not be necessary—a French retrospective cohort

Contact Info

Product

Resources

About