Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas

Schloericke, Erik; Hoffmann, Martin; Zimmermann, Markus; Kraus, Mordechai; Bouchard, R.; Roblick, UJ; Hildebrand, P.; Nolde, J.; Bruch, Hans–Peter; Limmer, Stefan

doi:10.1111/j.1463-1318.2011.02719.x

Cited by 28 publications

(14 citation statements)

References 27 publications

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“…79,80 However, inferior results are seen in irradiated patients. 81,82 Due to good results and low morbidity, proponents of mesh suggest that this technique should be the first step in the treatment of RVF, prior to GMFI. Larger randomized trials are needed to better evaluate the role and cost-effectiveness of bioabsorbable mesh in the management of complex RVF.…”

Section: Bioabsorbable Mesh Interpositionmentioning

confidence: 99%

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Management of Complex Perineal Fistula Disease

Akiba

Rodrigues

Silva

2016

Clinics in Colon and Rectal Surgery

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Management of complex perineal fistulas such as high perianal, rectovaginal, pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic approach. The first step is to control any sepsis with drainage of abscess and/or seton placement. Patients with large, recurrent, irradiated fistulas benefit from stoma diversion. In patients with Crohn's disease, it is essential to induce remission prior to any repair. There are different approaches to repair complex fistulas, from local repairs to transperineal and transabdominal approaches. Simpler fistulas are amenable to local repair. More complex fistulas, such as those secondary to irradiation, require interposition of healthy, well-vascularized tissue. The most common flap used for this treatment is the gracilis muscle with good outcomes reported. Once healing is confirmed by imaging and endoscopy, the stoma is reversed.

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Section: Bioabsorbable Mesh Interpositionmentioning

confidence: 99%

“…If the rectum is relatively preserved, separation of the fistula with omental interposition offers success rates of 90 to 100%. 82,83 If the rectum is damaged and anal function is preserved, low anterior resection with fistula tract excision and coloanal anastomosis can be performed. 84…”

Section: Transabdominalmentioning

confidence: 99%

Management of Complex Perineal Fistula Disease

Akiba

Rodrigues

Silva

2016

Clinics in Colon and Rectal Surgery

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“…A mobilized, pedicled omental graft has been described in treatment of complex rectovaginal fistulas. 9 The omentum has a good blood supply, derived from the left and right gastroepiploic arteries; it is known for its role in resolving (abdominal) infections and has been successfully used in complicated vaginal fistula repair. In our study, the omental graft was used in one patient with a pouch-neovaginal fistula with a good result and without any complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Management of Neovaginal Fistulas After Vaginoplasty in Transgender Women

Sluis

Bouman

Buncamper

et al. 2016

Obstetrics &Amp; Gynecology

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Neovaginal fistulas are uncommon after vaginoplasty. Symptoms of neovaginal fistulas are comparable with those of vaginal fistulas. In most patients, the diagnosis can be made based on symptoms and physical examination alone. It seems that a complicated course (eg, intraoperative rectal perforation or meatal stenosis) predisposes for fistula formation. Surgical repair of neovaginal fistulas is associated with few intraoperative and postoperative complications and does not seem to impair neovaginal function.

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“…Bricker-Johnston sigmoid colon graft [ 30 ] and its modification proposed by Steichen [ 31 ] was successfully applied in a 61-year-old female with RI-RVF with good functional results but following the three-stage procedure. More recently, Zimmermann described the ultra-deep anterior rectum resection with transperineal and transvaginal omentum reconstruction coupled with protective ileostomy construction that his team used to treat a 37-year-old woman with RI-RVF [ 32 ]. Authors of these reports observed that the described techniques are efficient in cases of high fistulas and emphasized the careful selection of patients fit for the procedures.…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies—new patients, old problem?

Zelga¹,

Tchórzewski²,

Zelga³

et al. 2016

Langenbecks Arch Surg

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PurposeRadiation-induced rectovaginal fistula (RI-RVF) is a chronic and serious condition with a significant influence on quality of life. The aim of this study is to evaluate the results of surgical treatment of rectovaginal fistulas of patients previously undergoing radiotherapy.MethodsFifty patients treated in the Gynaecological Radiotherapy Unit for gynaecologic malignancy and in the Department of General and Colorectal Surgery for RI-RVF between 2003 and 2013 were enrolled into a prospectively maintained database and underwent regular follow-up examinations in an outpatient clinic, during which surgical outcomes were assessed.ResultsMedian age was 60 years (range 40–84 years). Cervical cancer was the most common cause of radiotherapy. Median time of fistula development after radiotherapy was 20 months (range 5–240 months). In 48 (96%) patients, only faecal diversion could be performed, while two patients underwent rectal resection. The fistula healed in six patients. Factors that correlated with fistula healing were a distance from the anal verge above 7 cm (p = 0.007 OR 18 95%CI 2.2609–14.3062) and creation of loop ileostomy (p = 0.08 OR 17 95%CI 1.2818–23.9701), whereas a prolonged course of radiotherapy of more than 6 weeks (p = 0.047) correlated negatively. In multivariate analysis, only distance from the anal verge remained significant (p = 0.031 OR 2.35 95%CI 1.0422–5.2924).ConclusionsThe treatment of radiation-induced rectovaginal fistulas needs to be tailored individually to each patient. Faecal diversion remains the simplest and safest method of treating RI-RVF, especially in the group of patients who cannot undergo complicated surgical procedures, and offers acceptable quality of life.

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Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas

Abstract: Complete omental reconstruction of the rectovaginal space appears decisive in the operative therapy of deep rectovaginal or enterovaginal fistulas. Comparative studies on standard therapies are necessary although direct comparison of case series is difficult.

Cited by 28 publications

References 27 publications

Management of Complex Perineal Fistula Disease

Management of Complex Perineal Fistula Disease

Clinical Characteristics and Management of Neovaginal Fistulas After Vaginoplasty in Transgender Women

Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies—new patients, old problem?

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