[Surgical treatment and prognosis of rectovaginal fistulae according to their origin]. / Chirurgische Versorgung und Prognose rektovaginaler Fisteln in Abhängigkeit ihrer Genese.
Zentralbl Chir
; 137(4): 390-5, 2012 Aug.
Article
em De
| MEDLINE
| ID: mdl-22473673
INTRODUCTION: The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis. MATERIAL AND METHODS: Between 1 /â2000 and 1 /â2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data. RESULTS: In a timespan of ten years 36âpatients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (nâ= 21) and earlier surgical measures (nâ= 6). Moreover tumour-associated fistulas (nâ= 5) and fistulas with unknown genesis (nâ= 4) were seen. As surgical techniques anterior resection (nâ= 21), transrectal flap plasty (nâ= 7), subtotal colectomy (nâ= 3), pelvine exenteration (nâ= 2) and rectal exstirpation (nâ= 1) were used. The closure of the vaginal lesion was performed by single suture (nâ= 25), flap plasty (nâ= 6), transvaginal omental plasty (nâ= 2) and posterior vaginal plasty (nâ= 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12âmonths (6 - 36). Within this timespan 6âpatients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (nâ= 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence). CONCLUSION: The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fístula Retovaginal
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged80
Idioma:
De
Revista:
Zentralbl Chir
Ano de publicação:
2012
Tipo de documento:
Article