Colgajo de Martius como tratamiento de una fístula rectovaginal recidivada: revisión de la técnica quirúrgica a propósito de un caso clínico / Martius Flap for recurrent Rectovaginal Fístula: clinical Case and surgical approach

Resumen Introducción: La fístula rectovaginal es una patología quirúrgica compleja de tratar. El trauma perineal obstétrico y las enfermedades inflamatorias intestinales, especialmente la Enfermedad de Crohn son las causas más frecuentes. La reparación quirúrgica con un Colgajo de Martius en manos experimentadas ha mostrado buenos resultados con mínima morbilidad en pacientes seleccionados. Material y Método: Presentamos un caso clínico de una paciente que cursó con una fístula rectovaginal posparto tardía, la cual tuvo una recurrencia precoz, luego de intentar tratamiento quirúrgico consistente en un colgajo de avance, siendo necesaria la desfuncionalización del tránsito con una colostomía en asa. Posteriormente se realizó un Colgajo de Martius con resultado exitoso. Resultados: Evolución satisfactoria. Cursó con dehiscencia de la herida perineal la cual requirió solo curaciones ambulatorias. Luego de 8 meses posterior a la confección del Colgajo de Martius, se realizó el cierre de colostomía. A los 30 meses poscolgajo, la paciente se encuentra en buenas condiciones, sin evidencia de recidiva y tránsito intestinal normal. Conclusión: En este caso clínico, el colgajo de Martius fue una alternativa segura y efectiva en el tratamiento de una fístula rectovaginal recidivada.

Introduction: The rectovaginal fistula is a complex surgical pathology to treat. Obstetric perineal trauma and inflammatory bowel diseases, especially Crohn's disease, are the most frequent causes. Surgical repair with a Martius flap in experienced hands has shown good results with minimal morbidity in selected patients. Material and Methods: We present a clinical case of a patient who had a late postpartum rectovaginal fistula, which recurred early after attempting surgical treatment consisting of an advancement flap, requiring defunctionalization of the transit with a loop colostomy. Subsequently, a Martius flap was performed with a successful result. Results: Satisfactory evolution. The patient presented a dehiscence of the perineal wound which required only ambulatory dressings. At 8 months from the Martius flap was made, the colostomy was closed. At 30 months post-flap, the patient is in good condition, with no evidence of recurrence and normal intestinal transit. Conclusión: In this clinical case, the Martius flap was a safe and effective alternative in the treatment of a recurrent rectovaginal fistula.

Rectovaginal fistula: An early complication of radiotherapy in a sexagenarian with cervical cancer

A 62-year-old Nigerian woman was admitted on account of cervical carcinoma Stage IV and was requested to undergo radiotherapy and chemotherapy. Six weeks after commencing this treatment she starting passing feces involuntarily through the vagina. Imaging studies revealed a high sited, medium sized, and rectovaginal fistula (RVF). RVFs have been documented as a late complication of radiotherapy for any gynecological malignancy but it occurred earlier in this patient. A preliminary surgical procedure, a sigmoid-ostomy, was performed successfully and a definitive surgery, a sigmoido-rectal anastomosis, was planned to be done in 18 months after the diagnosis of the RVF but the patient died shortly after the first procedure. The present case indicates that a RVF can occur as an early complication of radiotherapy even when it presents with mild symptoms.

Comparison of MRI and endorectal ultrasonography in diagnosis of rectovaginal fistula / 中国医学影像技术

Objective: To compare the value of MRI and endorectal ultrasonography (ERUS) in diagnosis of rectovaginal fistula (RVF). Methods: Data of 51 patients with suspected RVF who underwent preoperative MRI and ERUS were retrospectively analyzed. Then all RVFs were classified according to the cause and complexity, respectively. Taken surgical operation outcomes as standards, the sensitivity, specificity and accuracy of MRI and ERUS in diagnosis of RVF were evaluated, and the detection rate of MRI and ERUS for various types of RVF were compared and analyzed. The consistency of MRI and ERUS diagnosis results with surgical results, also between MRI and ERUS diagnosis results were analyzed. Results: RVF were confirmed in 40 cases with surgical operation. No statistical difference of the sensitivity, specificity and accuracy of MRI (85.00%, 90.90%, 86.27%) nor ERUS (80.00%, 100%, 84.31%) with surgical operation was found (χ2=0.17, 0.05).Strong consistency of MRI and ERUS diagnostic results were found with surgical diagnosis (Kappa=0.65, 0.63, both P0.05). Conclusion: Both MRI and ERUS can be used to diagnose RVF. ERUS is recommended as the preferred examination for simple RVF, while the combination of MRI and ERUS can improve the detection rate of complex RVF.

Transvaginal pedicled omentum pull-through combined transanal colon pull-through for the treatment of vesicorectovaginal fistula / 中华普通外科杂志

Objective@#To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.@*Methods@#A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed. In order to isolate, protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through, combined transanal colon pull-through to repair vesicorectovaginal fistula.@*Results@#All the 11 patients in this group completed the operation successfully, and no air or stool passing from the vaginal after the operation. The fistula disappeared in five patients confirmed by cystography and enterograph. The average operation time was 115 min, the average blood loss was 260 ml.Incision fat liquefaction was found in two. Incision infection occurred in one. Urinary dysfunction in two. Anal stenosis was found in four patients which were healed by anal dilation.@*Conclusions@#Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula, improve life quality and avoid colostomy.

Transvaginal pedicled omentum pull-through combined transanal colon pull-through for the treatment of vesicorectovaginal fistula / 中华普通外科杂志

Objective To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.Methods A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed.In order to isolate,protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through,combined transanal colon pull-through to repair vesicorectovaginal fistula.Results All the 11 patients in this group completed the operation successfully,and no air or stool passing from the vaginal after the operation.The fistula disappeared in five patients confirmed by cystography and enterograph.The average operation time was 115 min,the average blood loss was 260 ml.Incision fat liquefaction was found in two.Incision infection occurred in one.Urinary dysfunction in two.Anal stenosis was found in four patients which were healed by anal dilation.Conclusions Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula,improve life quality and avoid colostomy.

Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula

Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently, no single surgical intervention is universally regarded as the best treatment option for rectovaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically treated with a gracilis pull-through flap. The surgical goals in this patient were complete excision of the recto-vaginal fistula and introduction of fresh, vascularized muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior to the present procedure. The gracilis muscle and tendon were mobilized, pulled through the freshened recto-vaginal fistula, passed through the anus, and anchored externally. Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage. At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia. At 6 months post-procedure, her stoma was closed. The patient reported transient fecal staining of her vagina after stoma reversal, which resolved with conservative treatment. The fistula had not recurred at 20 months post-procedure. The gracilis pull-through flap is a reliable technique for a scarred vagina with an attenuated rectovaginal septum. It can function as a well-vascularized tissue plug to promote healing.

Optimal strategies of rectovaginal fistula after rectal cancer surgery

PURPOSE: Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is a type of anastomotic leakage. The aim of this study was to find out the difference of leakage, according to RVF presence or absence and to identify the optimal strategy for RVF. METHODS: All female patients who underwent low anterior resection with colorectal anastomosis or coloanal anastomosis (n = 950) were retrospectively analyzed. Patients' demographics and perioperative outcomes were analyzed between the RVF group and leakage without the RVF (nRVF) group. We performed 4 types of procedures—primary repair, diverting stoma, redo coloanal anastomosis (RCA), and conservative procedure—to treat RVF, and calculated the success rates of each type of procedure. RESULTS: The leakage occurred in 47 patients (4.9%). Among them, 18 patients (1.9%) underwent an RVF and 29 (3.0%) underwent nRVF. The RVF group received more perioperative radiotherapy (27.8% vs. 3.4%, P < 0.015) and occurred late onset after surgery (181.3 ± 176.4 days vs. 23.2 ± 53.6 days, P < 0.001) more than did the nRVF group. In multivariate analysis for the risk factor of the RVF group, the RVF group was statistically associated with less than 5 cm of anastomosis more than was the no-leakage group. A total of 35 procedures were performed in 18 patients with RVF for treatment. RCA showed satisfactory success rates (85.7%, n = 6) and, primary repair (transanal or transvaginal) showed acceptable success rate (33.3%, n = 8). CONCLUSION: After low anterior resection for rectal cancer, RVF was strongly correlated with a lower level of primary tumor location. Among the patients who underwent leakages, receipt of perioperative radiotherapy was significantly high in the RVF group than that of the nRVF group. Additionally, this study suggests that RCA might be considered another successful treatment strategy for RVF.

Prevalence of high-grade perineal tear during labor in Mexican adolescents / Prevalencia de desgarro de alto grado en parto de adolescentes mexicanas

Abstract Introduction: There is a high rate of deliveries in adolescents in Mexico. This age group is vulnerable to obstetric complications, including lacerations of the anal sphincter. Objective: To determine the prevalence of third and fourth degree perineal tears in adolescents during childbirth, and to evaluate risk factors in comparison with deliveries with lacerations of adult women. Methods: All obstetric care episodes were reviewed from a public tertiary hospital data in Monterrey, Mexico in 2014. Age, primiparity, delivery instrumentation, episiotomy, body mass index, product weight and tear´s degree were documented at the deliveries with tears of third and fourth degree. Results: The prevalence of third and fourth degree tears of 2.0% was found in the general population, being adolescents the most affected with 2.5%. The unadjusted odds ratio of high-grade tears in adolescent females at delivery, compared to adult females, was 1.36 (95% CI = 0.99-1.86, p= 0.05). No difference was found when comparing risk factors among high-grade tear deliveries in adolescents versus adults. Conclusions: A higher prevalence than previous reported for high grade tears during delivery was found. The data suggest adolescence as a risk factor for high-grade tears during delivery.

Resumen Introducción: En México hay una elevada tasa de partos en adolescentes. Este grupo es vulnerable para complicaciones obstétricas, entre ellas laceración del esfínter anal. Objetivo: Conocer la prevalencia de desgarros perineales de tercer y cuarto grado en adolescentes durante el parto y evaluar factores de riesgo en comparación con partos con laceración de mujeres adultas. Métodos: Se revisaron todas las atenciones obstétricas en un hospital publico de tercer nivel en Monterrey, Nuevo León, México en el año 2014. Se documentó edad, primiparidad, instrumentación del parto, realización de episiotomía, índice de masa corporal, peso del producto y grado del desgarro en los partos que presentaron desgarros de tercer y cuarto grado Resultados: Se encontró una prevalencia general de 2.0% de desgarros de tercer y cuarto grado y en adolescentes de 2.5%. La razón de momios sin ajustar de desgarros de alto grado en mujeres adolescentes en comparación con mujeres adultas fue de 1.36 (IC 95%= 0.99-1.86, p= 0.05). No se encontró diferencia al comparar factores de riesgo entre los partos con desgarro de alto grado en adolescentes contra adultas. Conclusiones: Se encontró una prevalencia mayor a lo reportado de desgarros de alto grado durante el parto. Los datos sugieren a la adolescencia como factor de riesgo para desgarros de alto grado.

Manejo de la fístula ano-recto-vaginal compleja mediante el procedimiento de Martius: reporte de cinco casos / Martius procedure in complex anorectal-vaginal fistula management: five-case report

La reparación de fístulas ano-recto-vaginales complejas representa un reto anatomoquirúrgico para el cirujano, debiendo seleccionarse el procedimiento quirúrgico adecuado para cada caso. El procedimiento de Martius consiste en la trasposición del músculo bulbocavernoso para reparar la fístula recto-vaginal. Se presentan cinco casos de fístulas ano-recto-vaginales reparadas por este procedimiento desde el 2010 hasta el 2014. La edad promedio fue de 38,2 años, tres fístulas (60%) fueron de etiología obstétrica, una inducida por radiación y otra de etiología desconocida. El seguimiento promedio fue de 25 meses, con una tasa de éxito de 100%. El procedimiento de Martius es una buena alternativa para la reparación quirúrgica de fístulas ano-recto-vaginales complejas.

The repair of complex anorectal-vaginal fistulas represents an anatomic-surgical challenge for the surgeon, and the appropriate surgical procedure must be selected for each case. The procedure of Martius is described as the transposition of the bulbocavernosus muscle to repair the recto-vaginal fistula. Five cases of anorectal-vaginal fistulae were repaired by this procedure from 2010 to 2014. The mean age was 38.2 years; three fistulas (60%) were of obstetric etiology, one induced by radiation and one of unknown etiology. The mean follow-up was 25 months, with a 100% success rate. The Martius procedure is a good alternative for the surgical repair of complex anorectal-vaginal fistulas.

Anastomotic leakage after rectal cancer surgery: classification and management / 中华胃肠外科杂志

Many studies have focused on the identification of risk factors and prevention of anastomotic leakage following rectal cancer surgery. However, there is little knowledge regarding classification and management of anastomotic leakage in clinic. Herein, we reviewed and summarized the classification and management of anastomotic leakage after rectal cancer surgery. The relevant treatments of anastomotic leakage should be chosen based on patient's manifestation, including general and local reactions, anatomical location, and nature of the leakage (contained or free, controlled or uncontrolled leakage) . 1) Surgery is imperative for anastomotic leakage with acute general peritonitis and sepsis. 2) Circumscribed peritonitis and the pelvic abscess can be managed conservatively with complete drainage. During the conservative management, diverting stoma, minimally invasive techniques of seal or repair should be implemented at an appropriate time, if necessary. 3) Subclinical leakage seldom requires surgical intervention promptly. 4) For persistent anastomotic leakage after diverting stoma, we should consider whether chronic presacral abscess, epithelialized sinus, fistula or local recurrence of cancer is present. With regard to definitive salvage surgery, reconstruction of the coloanal anastomosis or permanent stoma is usually required under these circumstances. 5) Complicated fistula often necessitates surgical repair with advancement tissue flap or tissue interposition under the condition of diversion. Reconstructing the coloanal anastomosis is the alternative management, whereas other treatments are invalid, including ultra-low anterior resection, intersphincteric resection, proctectomy with colon pull-through, and primary or staged coloanal anastomosis. 6) During the surgical repair of recto-vaginal fistula and recto-urinary fistula, colorectal surgeons may require the cooperation of gynecologists, urologists, and orthopedists. 7) For anastomotic leakage with local recurrence of cancer after conservative management, diverting stoma should be performed promptly to facilitate the subsequent chemoradiotherapy. Surgeons should pay more attention to systemic knowledge and understanding of the classification and management of anastomotic leakage following rectal cancer surgery. Accordingly, we can follow the principles of management, individualize the treatments, apply the concepts of damage control and minimally invasive surgery, and enhance the recovery of anastomotic leakage. Prevention remains more important than remedies. To prevent the occurrence of permanent injuries, not only early diagnoses and treatments should be performed, but also the timing of cancer treatments is warranted for anastomotic leakage.

Alternativas quirúrgicas en el manejo de la fístula rectovaginal: experiencia de 25 años / Surgical procedures for rectovaginal fistula: 25-years experience

Antecedentes: La fístula rectovaginal (FRV) es una patología de origen muy variado y el tratamiento representa un verdadero desafío terapéutico. No existen estudios prospectivos que orienten sobre el manejo de estas lesiones. Objetivo: Evaluar los resultados del tratamiento quirúrgico de las pacientes con una FRV. Material y método: Estudio descriptivo retrospectivo en el cual se incluyen todas las pacientes intervenidas en un periodo de 25 años. Resultados: Se trata de 63 pacientes con una FRV, la mitad secundaria a una neoplasia y un 27% secundaria al tratamiento radiante de tumores pélvicos. El trauma local y las FRV postoperatorias representan el 28% de los casos. El abordaje de la FRV fue abdominal en 26 pacientes (41%), resecando la FRV neoplásica en 11 y efectuando una cirugía reconstructiva en 15 actínicas. En 17 pacientes con una FRV por persistencia tumoral solo se efectuó una desfuncionalización proximal. De las 5 pacientes con una FRV iatrogénica, en 4 se logró el cierre espontáneo mediante una ostomía transitoria y los 7 casos de FRV posparto fueron reparadas con un abordaje local con resultados satisfactorios en 6. Conclusiones: En este estudio el abordaje local de la FRV se utilizó en 12 casos; el 33% (21/63) de los casos necesitó una ostomía definitiva y en el 40% de las fístulas complejas se logró el cierre de la fístula con conservación esfinteriana. Las series de FRV publicadas son muy heterogéneas, probablemente debido a patrones de referencia muy variables, lo que hace muy difícil realizar un análisis comparativo.

Background: Rectovaginal fistula (RVF) is a distressing condition with no generally accepted standard surgical management. Aim: To assess results of surgery for RVF. Material and method: This is a descriptive retrospective analysis of 63 patients operated on consecutively for RVF in a period of 25 years. Results: Halve of the cases were secondary to a pelvic malignancy and 27% due to radiotherapy of pelvic tumors. RVFs were associated with local (obstetrical) trauma and postsurgical complications in 28% of the cases. High RVFs were approached through abdominal procedures in 26 patients (41%), including radical resection of the primary tumor in 11 cases and coloanal sleeve anastomosis procedure in 15 patients with a RVF due to pelvic radiation. Seventeen patients with persistent pelvic tumors after radiotherapy and/or surgery were handled with a colostomy or ileostomy to improve quality of life. Four of five cases with postsurgical RVF closed spontaneously with a proximal colostomy and, in seven patients with obstetrical RVF, an advancement flaps were performed, with success in 6. Conclusions: In this study local repair of RVF was employed in 12 cases, one third of the cases needed a permanent ostomy, and 40% of the complex cases of RVF were successfully repaired with sphincter preservation. Comparisons with other studies are precluded because of heterogeneity of published RVF series, probably due to different patterns of reference.

Anterior Anorectocolonic Tubular Duplication Presenting as Rectovestibular Fistula in an Infant / 소아외과

Anorectal duplications account for only 5% of gastrointestinal duplications, and cases with involvement of the anal canal are much rarer. Nearly all anorectal duplications are posterior to the rectum; duplications located anterior to the normal rectum are highly unusual, and only a few cases have been reported. We report the case of an anterior anorectocolonic duplication presenting as a rectovaginal fistula in a 2-month-old infant. After diagnosis, the duplication was excised completely without further intestinal complications.

Progress of surgical management of radiation proctitis / 医学研究生学报

Radiation proctitis is one of the complications after radiotherapy for pelvic malignancies.Surgery is not necessary for the most of radiation proctitis.However, surgery is unavoidable when rectal obstruction, uncontrollable bleeding, and fistula occur. This article reviews the progress in surgical treatment of radiation proctitis.

Unilateral Functional Uterine Horn with Non Functioning Rudimentary Horn and Cervico-Vaginal Agenesis: Case Report.

Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with primary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rectovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. Adiagnosis of hematometra with iatrogenic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lateral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides.

Coloplastia vaginal, una opción en el tratamiento de la fístula rectovaginal grande / Vaginal coloplasty, an option in the treatment of large rectovaginal fistula

Objetivo: Presentar un tratamiento alternativo para una fistula recto vaginal grande producida por la radiación en una mujer joven tratada por cáncer de cuello uterino, basado en las sigmoideoplastias vaginales en pacientes con agenesia de vagina. Paciente y método: Paciente de sexo Femenino de 36 años que el año 2010 concurre al consultorio de proctología por presentar proctorragia asociada a la defecación de dos semanas de evolución. Antecedentes de conización en el año 2008 por carcinoma epidermoide de cuello uterino y en 2009 irradiada con braquiterapia y radioterapia por presentar recidiva en vagina de cáncer de cuello uterino. Se decide la internación y al día siguiente es llevada a quirófano donde se observa a nivel de recto inferior y medio, fístula con tercio medio e inferior de vagina de unos 4 a 5 cm de diámetro. Dada las características de la misma, el grado de incontinencia de la paciente, su retracción inmediata de sus actividades laborales y sociales, se le plantea la posibilidad de desfuncionalizarla resecado el recto medio e inferior, completar la cirugía oncológica de su cáncer y en un segundo acto reconstruir tanto el tránsito intestinal como su vagina con un segmento vascularizado de colon. Discusión: Existen varias formas de clasificar una fistula rectovaginal, en base a su ubicación, según su diámetro, por último se pueden clasificar según su complejidad en simples y complejas. Dentro de los tratamientos hallamos los perineales, rectales o vaginales, indicados en las fistulas bajas o medias y los abdominales en las fistulas altas. Existen algunas que no responde a los tratamientos habituales o que desde un principio no se pueden tratar por las técnicas habituales, llevando en contadas ocasiones a tratamientos más agresivos como la desfuncionalización, colgajos miocutáneos o la técnica de Simonsen.

Purpose: to present an alternative treatment for rectovaginal fistula secondary to radiation in a young female patient treated for cervical cancer, based on a vaginal sigmoideoplasty. Patient and Method: 36 years old female patient with a 2-week history of rectal bleeding. Personal history of conization in 2008 for cervical squamous carcinoma and postoperative treatment in 2009 with brachytherapy and radiaton therapy for local cancer recurrence. On surgical perineal exploration a recto-vaginal defect of 4-5 cm was identified in the middle-lower vagina. Proctectomy was performed based in surgical principles. During reconstructive surgery the vagina was replaced with a colonic segment. Results: there are several ways to classify a rectovaginal fistula, based on location, diameter and according to their complexity into simple and complex. Rectal, perineal and vaginal approaches have been described. In some cases, more aggressive techniques could be performed such as myocutaneous flaps and Simonsen technique.

Treatment strategy of rectovaginal fistula after rectal cancer operation / 肿瘤研究与临床

Objective To investigate the cause,therapeutic strategy,methods of treatment and clinical results for the rectovaginal fistulas(RVF)after rectal cancer operations.Methods The clinical data of 14 female patients with RVF after rectal cancer operations were examined retrospectively.According to therapeutic strategy,all patients were divided into two groups,A group and B group,which were seperately performed traditional treatment,and progynova in combination with non-operative treatment.Results Among 10 patients in A group,8 patients were performed feacal diversion stoma,and 7 patients with RVF cured naturally,then performued colostomy reversal and restoration of bowel continuity,the other 2 cases were performed non-operative treatment for refusing feacal diversion stoma.Among 4 patients in B group,3 cases with RVF healed naturally during 1.5 to 2 months,one case secondary to rectal anastomosis was performed feacal diversion stoma for rectovaginal fistula without signs of healing.Conclusion RVF is a rare but serious complication after resection of rectal carcinoma,which is taken by the treatment strategy of progynova in combination with non-operative treatment,not only can promote the natural healing of RVF obviously,but also can shorten the healing time greatly.Feacal diversion stoma can be used while the treatment is failure.

Application of acellular allograft dermal tissue patch in the repair of transvaginal rectovaginal fistula / 中华妇产科杂志

Objective To investigate the clinical effect of acellular allograft dermal tissue patch used in transvaginal rectovaginal fistula repair.Methods From Jan.2008 to Dec.2011,22 patients with rectovaginal fistula undergoing treatment in Chinese People's Liberation Army General Hospital were studied retrospectively.Twelve patients treated by tissue patch were classified into study group matched with 10 patients with general surgery as controls.Results In study group,11 patients were successfully repaired by their first surgery; one patient was successfully fixed by the second surgery.The successful rate of first operation was 11/12 in study group and 4/5 in recurrent transvaginal rectovaginal fistula.In control group,7 patients were fixed successfully in their first surgeries,the successful rate of first surgery was 7/10.Two primary patients and 1 recurrent patient were successfully fixed by their second surgeries.All of the patients were followed up for (9.0 ± 2.0) months,and no recurrence diseases were observed.Conclusion The transvaginal rectovaginal fistula fixed using acellular allografi dermal tissue patch could get less trauma and higher cure rate.

Mason surgical treatment of recurrent rectovaginal fistula in 13 cases / 中国医师进修杂志

Objective To investigate the surgical strategy of recurrent rectuvaginal fistula. Methods Retrospectivly analyzed the clinical data of 13 patients with recurrent rectovaginal fistula from December 2001 to December 2008. The etiopathogenisis and the ways of treatment were analyzed. Results All the 13 patients with a transverse colostomy surgical repaired with Mason operation in the secondary intention,and recepted closure of colostomy in the third intention for treatment, all patients were cured. No recurrent fistula was identified with postoperative follow-up 4 - 84 months. Conclusions After recurrent rectovaginal fistula with multiple surgical treatment,the blood supply of local tissue is poor,the scar is serious. Selecting the appropriate timing of operation, adequate preoperative preparation, the application of transverse colostomy and Mason operation in different period could significantly enhance the successful operation rate.

Fístula rectovaginal posobstétrica: tratamiento quirúrgico mediante avance de colgajo endorrectal / Postobstetric rectovaginal fistula: surgical treatment using endorectal advancement flap

Introducción: Las fístulas rectovaginales ocurren con una frecuencia menor a 5 % respecto a otros tipos de fístulas de la región anorrectal; el trauma obstétrico es la causa más común de este tipo de fístulas. Existen diversos procedimientos quirúrgicos para la reparación de las mismas. Material y métodos: Se realizó un estudio de 16 pacientes con diagnóstico de fístula rectovaginal posobtétrica, atendidas en el Hospital Juárez de México entre enero de 1992 y diciembre de 2006. Se analizó edad de las pacientes, tipo de trauma obstétrico, tiempo de inicio de la sintomatología después del parto, localización y tamaño de la fístula, índice de éxito y recidivas mediante el tratamiento con avance de colgajo endorrectal, y necesidad de esfinteroplastia complementaria. Resultados: La edad promedio fue de 25.6 años. En todas las pacientes, la sintomatología inició después de un parto vaginal durante el cual se realizó episiotomía o hubo desgarro perineal. Todas las fístulas fueron menores de 2.5 cm de diámetro y de localización baja. Con el colon preparado, en todas las pacientes se reparó la fístula rectovaginal mediante avance de colgajo endorrectal. En dos pacientes se llevó acabo, además, esfinteroplastia del esfínter anal. Los resultados fueron satisfactorios en 15 pacientes (93.7 %); no hubo mortalidad operatoria y no fueron utilizados estomas de protección. Conclusiones: El colgajo endorrectal es un procedimiento seguro para la reparación de fístulas rectovaginales de origen posobstétrico, algunos casos pueden requerir esfinteroplastia del esfínter anal.

BACKGROUND: Rectovaginal fistulas account for <5% of all rectal fistulas. Obstetrical injuries are the most common cause of these types of fistulas. There have been a multitude of surgical approaches developed for operative repair. METHODS: Between January 1992 and December 2006, 16 patients with postobstetric rectovaginal fistula were treated at the Hospital Juárez of México. Age, type of obstetric trauma, time elapsed between delivery and beginning of symptoms, location, and size of the fistulas, rate of success and recurrence with the use of endorectal flap, and need for complementary sphincteroplasty were all evaluated. RESULTS: Median age of the patients was 25.6 years. All women reported that their symptoms began after a vaginal delivery that included an episiotomy or 4th degree laceration. All fistulas were low and small (<2.5 cm in diameter). Patients received bowel preparation and underwent rectovaginal repair using endorectal advancement flap. In two cases, additional overlap repair of the anal sphincter was performed. Result of repair was good to excellent in 15 patients (93.7%). There were no operative mortalities, and no covering stomas were used. CONCLUSIONS: Endorectal flap repair provides successful postobstetric rectovaginal fistula closure. Concomitant sphincteroplasty may be necessary in some cases.

Risk factor analysis on rectovaginal fistula after resection in rectal cancer / 国际外科学杂志

Objective To investigate the risk factors on rectovaginal fistula after resection in rectal canc-er and clinical strategy. Methods Our retrospective study included 1123 patients of recter cancer who un-derwent anterior resection with TME technique. Results 3.03% patients(34/1123) developed reetovaginal fistula. Rectovaginal fistulas were raleted with menopausal, location tumor in rectal wall and distance between tumor and anal verge, anastomotic technique, while not with age, T stage, preoperative radiotherapy, diversion stoma construction. Among 34 patients 12 were cured conservatively, fistula repair and colon stoma were performed for the other patients. Conclusions Menopausal, location tumor in rectal wall, distance between tumor and anal verge, anastomotic technique were risk factors for rectovaginal fistula after resection in rectal cancer. Correct choice of surgical procedures, suitable operative timing, enough preoperative preparation are important.