Long-term success of complex recurrent rectovaginal fistula repair.

Rectovaginal fistulas (RVF) are the cause of major affliction to the affected patient and are a foremost challenge for the attending surgeon. Traditional techniques for treatment of RVF are quite extensive and particularly invasive. A more local procedure, with an acceptable success rate, would be the ideal first approach in treatment of this particular ailment. The aim of the current study is to show the step-by-step technique to correct a complex recurrent RVF (rRVF) using a biomesh implant. A 61-year-old female, who had undergone a prior vaginal hysterectomy, presented with a complex recurrent RVF. A third attempt to repair the RVF was conducted by a surgical team with the utilization of a biomesh, which resulted in no further recurrence of symptoms or RVF for up to 4 years. Complex rRVF repair by the placement of the biomesh allows for a secure and sustainable closure with potentially better prognosis for the patients.

[Manometry and defecography in constipated patients with dyschezia]. / Manometría y defecografía en pacientes constipados con disquecia.

BACKGROUND: Constipation is one of the most frequent disorders in Gastroenterology. Radiologic and physiologic studies are essential to the diagnosis and treatment of constipated patients. OBJECTIVE: We aimed to assess the usefulness of manometry and defecography in constipated patients with suspect of dyssynergic defecation. METHODS: Dyschesic patients referred for anorectal testing, all patients underwent anorectal manometry and defecography. RESULTS: Fifty eight patients consecutive patients referred from 1998 to 2003. According to manometric findings patients were classified in patients without dyssynergia (group I, n = 16) and patients with dyssynergia (group II, n = 42). Group I patients had intussusception (75%), abnormal rectal emptying (56%), rectocele > 2.5 cm (56%), perineal descending (50%) and inadequate opening of the anal canal (38%). Group II patients had inadequate opening of the anal canal (69%), rectocele < 2.5 cm (55%), perineal descending (17%), intussusception (45%) and abnormal rectal emptying (55%). Group I had a higher frequency of perineal descending (p = 0.01) and intussusception (p = 0.044). Group II had a higher frequency of inadequate opening of the anal canal (p = 0.03), and not for inadequate opening of the anorectal angle. CONCLUSIONS: Defecography showed disorders in group I that may contribute to symptomatology, and in group II the inadequate opening of the anal canal suggests the participation of different parts of the external anal sphincter other than puborectalis in the genesis of dyssynergia.