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1.
Khirurgiia (Mosk) ; (4): 39-45, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33759467

RESUMO

OBJECTIVE: To evaluate the long-term results of surgical correction of H-type fistula in girls with a normal anus. MATERIAL AND METHODS: There were 7 patients with rectovestibular fistula and 3 patients with rectovaginal fistula with a normal anus were observed from 2014 to 2019 in the Surgical Department No. 1 of the Russian Children's Clinical Hospital. Upon admission, all patients underwent genital examination, vaginoscopy, rectal examination and probing the fistulous canal, irrigography, abdominal and retroperitoneal ultrasound. They were also examined by a gynecologist and genital smears were obtained. Surgical treatment was determined depending on the height and diameter of the fistula for each child. One patient underwent perineal fistulectomy, three patients - anterior anorectoplasty. Invaginated fistula extirpation, abdominoperineal proctoplasty and perineal fistulectomy using a pad flap between the defects were used in two cases, respectively. Patients were followed-up for the period from 6 months to 1 year after the last recurrence. Follow-up examination, irrigography and functional examination of sphincter were performed. RESULTS: Two (20%) patients did not require redo surgery. In 6 (60%) cases, recurrences didn't occur within a year after the second surgery, in 2 (20%) cases - after 3 operations. Recurrent H-type fistula appeared after 3 of 4 perineal fistulectomy procedures, 3 of 9 anterior anorectoplasty, 2 of 2 abdominoperineal proctoplasty and 2 of 3 invaginated fistula extirpation. Hypotension of internal anal sphincter and neo-rectal ampulla, recurrent vulvovaginitis were diagnosed in 2 patients in 6 months after anterior anorectoplasty. CONCLUSION: We recommend anterior anorectoplasty and perineal fistulectomy using a pad flap between the defects for the treatment of H-type fistula to minimize the risk of recurrence.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Fístula Retovaginal , Canal Anal/cirurgia , Criança , Feminino , Humanos , Períneo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Reto/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
2.
Arch Gynecol Obstet ; 302(2): 283-287, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32449060

RESUMO

PURPOSE: Pelvic organ prolapse (POP) presents a common benign condition in women associated with reduced quality of life (QoL). The use of pessaries is considered a first-line treatment of POP. However, pessaries can cause perforations into adjacent organs resulting in fistulas. We present a series of three cases of rectovaginal fistulas (RVF) due to pessary perforation. METHODS: Three consecutive cases of pessary-induced RVF in patients with POP stage IV were assessed between September 2016 and September 2019. Consensus for therapeutic strategy was reached by an interdisciplinary board. RESULTS: The RVF were located in the posterior vaginal wall and had a diameter of up to 60 mm. In one of three patients, a two-step approach was chosen with the ostomy being performed at the same time as fistula closure and modified LeFort colpocleisis. It was followed by ostomy closure 3 months later. In two patients, a three-step approach was chosen with the ostomy performed separately due to a local tissue inflammation around RVF. Neither fistula nor POP recurrences have occurred so far. CONCLUSION: Combined temporary gastrointestinal diversion, RVF closure and POP therapy can be performed as a two- or three-stage approach. Lack of evidence and standardized algorithms in RVF therapy make further clinical studies essential. We encourage the preoperative assessment of any case of complex rectovaginal fistula by an interdisciplinary board for determining an individualized treatment.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Pessários/efeitos adversos , Fístula Retovaginal/etiologia , Idoso de 80 Anos ou mais , Colpotomia , Feminino , Humanos , Histerectomia Vaginal , Osteotomia de Le Fort , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/psicologia , Complicações Pós-Operatórias , Qualidade de Vida , Fístula Retovaginal/cirurgia , Recidiva , Resultado do Tratamento
4.
Int J Gynaecol Obstet ; 148 Suppl 1: 9-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943185

RESUMO

Obstetric fistula is a neglected public health and human rights issue. It occurs almost exclusively in low-resource regions, resulting in permanent urinary and/or fecal incontinence. Although the exact prevalence remains unknown, it starkly outweighs the limited pool of skilled fistula surgeons needed to repair this childbirth injury. Several global movements have, however, enabled the international community to make major strides in recent decades. FIGO's Fistula Surgery Training Initiative, launched in 2012, has made significant gains in building the capacity of local fistula surgeons to steadily close the fistula treatment gap. Training and education are delivered via FIGO and partners' Global Competency-based Fistula Surgery Training Manual and tailored toward the needs and skill level of each trainee surgeon (FIGO Fellow). There are currently 62 Fellows from 22 fistula-affected countries on the training program, who have collectively performed over 10 000 surgical repairs. The initiative also contributes to the UN's Sustainable Development Goals (1, 3, 5, 8, 10, and 17). The UN's ambitious target to end fistula by 2030 will be unobtainable unless sufficient resources are mobilized and affected countries are empowered to develop their own sustainable eradication plans, including access to safe delivery and emergency obstetric services.


Assuntos
Obstetrícia/educação , Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Fortalecimento Institucional , Parto Obstétrico/efeitos adversos , Incontinência Fecal , Feminino , Humanos , Cooperação Internacional , Gravidez
5.
Int J Gynaecol Obstet ; 148 Suppl 1: 27-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943188

RESUMO

OBJECTIVE: To describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges. METHODS: A retrospective observational study of routinely collected health data from women treated via the MSO program (2013-2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico-surgical training, and community sensitization components. RESULTS: The MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1-81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts. CONCLUSION: The MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient-centered approach that brings medico-surgical care and psychosocial support to women with fistula in their own communities.


Assuntos
Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , República Democrática do Congo/epidemiologia , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Pobreza , Fístula Retovaginal/complicações , Fístula Retovaginal/epidemiologia , Estudos Retrospectivos , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/epidemiologia , Adulto Jovem
6.
J Laparoendosc Adv Surg Tech A ; 30(3): 350-354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30277838

RESUMO

Aim: This study aimed to compare the surgical outcomes of patients with the intermediate-type imperforate anus who underwent laparoscopically assisted anorectoplasty (LAARP; L group) with those of patients who underwent sacroperineal anorectoplasty (S group). Materials and Methods: The medical records of patients with intermediate-type imperforate anus at a single institution between April 1983 and April 2017 were retrospectively reviewed. Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies (maximum score, 8). Results: Twelve cases (rectobulbar urethral fistula, 7; anal agenesis without fistula, 4; and rectovaginal fistula, 1) were included in the L group versus 14 cases (rectobulbar urethral fistula, 11, and anal agenesis without fistula, 3) in the S group. Age and body weight at the time of surgery and rate of associated anomalies did not differ significantly between the two groups. The total scores for fecal continence 3, 5, and 7 years after anorectoplasty were 4, 5, and 4 points in the L group and 4, 5, and 6 points in the S group, respectively, showing no significant intergroup differences. Mucosal prolapse occurred in 50% of the L group and 29% of the S group (P = .42), but failed rectocutaneous anastomosis and anal stenosis were not identified in either group. Conclusions: Postoperative fecal continence and the incidence of complications after LAARP were comparable with those after sacroperineal anorectoplasty in patients with intermediate-type imperforate anus.


Assuntos
Malformações Anorretais/cirurgia , Anus Imperfurado/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retovaginal/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Canal Anal/cirurgia , Anastomose Cirúrgica , Peso Corporal , Incontinência Fecal/epidemiologia , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
7.
J Pediatr Surg ; 55(3): 393-396, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31072678

RESUMO

BACKGROUND: Anorectal malformations (ARMs) are major congenital malformations occurring in female children in approximately 1 out of every 4000-5000 births. Posterior sagittal anorectoplasty (PSARP) was introduced for their treatment in early 1980s by Pena and Devries. However, anterior sagittal anorectoplasty (ASARP) was first introduced by Okada as a modification of the previous technique. PURPOSE: The aim of this study was to report our experience and the long-term follow-up results of 594 female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. We chose this approach as the incision is smaller, with minimal cutting of the external sphincter and easier dissection of the vagina and rectum. The type of our study was retrospective study. RESULTS: The study included 594 patients; 342 of them were less than 1 year old. About 526 patients had rectovestibular fistula, anterior perineal anus in 55 patients, anocutaneous fistula in 6 patients and rectovaginal fistula in 7 patients. All of these patients had been subjected to ASARP technique which had been done in one stage without proceeding colostomy in about 470 cases and in staged fashion with a protective colostomy in 124 patients. Postoperative follow up revealed that four patients (0.7%) developed anal retraction, 30 patients (5%) developed anal stricture, 20 patients (3.4%) had rectal prolapse and 40 patients (6.7%) developed anterior anal migration. Constipation was observed in 161 patients (27%) by the end of 1st postoperative year reduced to 41 patients (7%) after one year. 474 patients were assessed for continence by Kelly's continence score and 453 patients showed good result, 16 patients showed fair result and about 5 patients had poor continence outcome. CONCLUSION: Anterior sagittal anorectoplasty is a procedure with optimal functional outcome especially at if done at an early age in one stage without preliminary colostomy.


Assuntos
Malformações Anorretais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Canal Anal/cirurgia , Constipação Intestinal , Feminino , Humanos , Lactente , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Fístula Retal/cirurgia , Fístula Retovaginal/cirurgia , Reto/cirurgia , Estudos Retrospectivos
8.
R I Med J (2013) ; 102(7): 21-24, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31480814

RESUMO

Obstetric fistula, an abnormal connection between a woman's genital tract and urinary tract or rectum, can be physically and psychosocially debilitating. We describe a sustainable obstetric fistula surgical trip model that includes providers from Women and Infants Hospital at Brown University. These surgical trips provide pre-operative, surgical, and post-operative care to patients with fistulae at Kibagabaga Hospital in Kigali, Rwanda. To ensure patients are prepared for the recovery process after fistula surgery, the team created a post-operative education curriculum that includes illustrative visual aids and teaching guides translated into Kinyarwanda, focusing on topics including urinary catheter care, wound care, and pain management. Through this program, the team is committed to restoring women's dignity through fistula repair as well as providing a model for delivery of sustainable surgical care in low-resource settings. Involvement of trainees into a global health team like this can benefit both the trainee and the patients served.


Assuntos
Obstetrícia/educação , Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , África ao Sul do Saara , Feminino , Humanos , Complicações do Trabalho de Parto , Gravidez , Fístula Retovaginal/reabilitação , Ruanda , Apoio ao Desenvolvimento de Recursos Humanos , Resultado do Tratamento , Fístula Vesicovaginal/reabilitação
9.
Anticancer Res ; 39(9): 5097-5103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519621

RESUMO

BACKGROUND/AIM: The reported incidence of rectovaginal fistula is very low. Although some case reports have described surgical procedures, no systematic approach to the treatment of rectovaginal fistula according to diagnostic image and colonoscopy findings has been proposed. We present a comprehensive surgical strategy for rectovaginal fistula after colorectal anastomosis according to diagnostic image and colonoscopy findings. PATIENTS AND METHODS: This retrospective study included 11 patients who developed rectovaginal fistula after colorectal anastomosis. Rectovaginal fistula was classified into 4 types according to contrast enema images and colonoscopy findings, i.e., "Alone type", "Dead space type", "Anastomotic stricture type", and "Dead space and Anastomotic stricture type". The surgical strategies were "Diversion (Stoma)", "Percutaneous drainage", "Anastomotic stricture type", "Endoscopic balloon dilation", "Curettage of foreign bodies", "Simple full-thickness closure", "Split-thickness closure", "Pedicled flaps packing", and "Reanastomosis". The surgical strategy appropriate for each rectovaginal fistula type was investigated. RESULTS: Among "Alone type" cases, 5 (71.4%) healed with "only Diversion (Stoma)". "Alone type" cases (n=11) and all other cases (n=4) healed with "only Diversion (Stoma)" (n=5) or any other method (n=6) (p=0.022). CONCLUSION: For treatment of rectovaginal fistula after colorectal anastomosis, less invasive treatment approaches should be attempted first.


Assuntos
Anastomose Cirúrgica , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Meios de Contraste , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Fístula Retovaginal/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral
11.
Int J Colorectal Dis ; 34(9): 1619-1623, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378835

RESUMO

PURPOSE: A rectovaginal fistula (RVF) is a rare disease. It's an epithelium-lined abnormal communication between rectum and vagina. It represents approximately 5% of all anorectal fistulas. RVF may have different causes. METHODS: We present a case of a 58-year-old woman with a rectovaginal fistula after stapled hemorrhoidopexy (Longo operation). RESULTS: A 58-year-old woman presented herself in our department with vaginal fecal discharge and vaginitis almost one month after a stapled hemorrhoidopexy was performed in another hospital. On vaginal examination, a large dorsal defect was palpated at four cm. On rectal examination, the stapler line was palpable at four cm and just distal to this stapler line, a large defect could be palpated. A lower gastrointestinal tract radiography was performed and identified a RVF. The patient was put on antibiotics and two operations were planned. First, a temporary ileostomy was created. After healing of the vaginitis, reconstructive surgery with anatomic fistula repair in combination with the interposition of healthy, vascularised tissue was performed. In this case, we chose the Martius flap. The operation as well as the postoperative course was uneventful. CONCLUSIONS: Cases of postoperative RVF have been increasingly reported since the introduction of stapled hemorrhoidopexy. Patients with RVF can have a varying degree of symptoms. Diagnosis is primarily based on the patient's medical history together with a clinical examination. There are many surgical approaches for RVF. Anatomic fistula repair alone is associated with lower success rates compared with combined procedures with the adjunctive interposition of healthy, vascularised tissue.


Assuntos
Hemorroidas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos/cirurgia , Grampeamento Cirúrgico , Bário , Enema , Feminino , Humanos , Pessoa de Meia-Idade , Fístula Retovaginal/diagnóstico por imagem
12.
Int Urogynecol J ; 30(10): 1659-1665, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31468097

RESUMO

INTRODUCTION AND HYPOTHESIS: We report the clinical outcome of surgical repair for rectovaginal fistula (RVF) carried out by one operative team. We also investigate the predictive factors for fistula healing. METHODS: A retrospective cohort of 63 patients underwent local surgical repair of RVF during January 2008 and December 2017 by one operative group. The clinical features of the patients were reviewed. The association between fistula closure and diverse clinical parameters, including operative method, fistula location, prior repair, and diverting stoma, was analyzed. RESULTS: Sixty-three consecutive patients underwent 80 local surgical repairs by our surgical team. Forty-five patients eventually healed after an average of 1.22 procedures. The overall success rate per procedure was 71.2%, whereas the closure rate of the first operation was 55.5% (n = 35). The etiology of the fistula did not impact on the success rate of surgical repair. The history of prior repair predicted a lower success rate on both overall procedure (RR = 0.59, 95% CI 0.41-0.85, p = 0.008) and the first repair in our institution (RR = 0.50, 95% CI 0.31-0.80, p = 0.003). There was no difference in closure rate between the stoma group and the non-stoma group. Nevertheless, among the 15 patients who underwent more than one operation in our center, a diverting stoma seemed to be necessary (10 patients healed in the stoma group and none of the patients healed in the non-stoma group, p = 0.02). CONCLUSIONS: History of prior surgical repair is a risk factor for failure. Diverting stoma did not increase the overall closure rate, but it seemed to be necessary for patients in whom the first operation failed.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Fístula Retovaginal/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estomas Cirúrgicos , Adulto Jovem
13.
Ann Ital Chir ; 82019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31310243

RESUMO

BACKGROUND: Radiotherapy currently plays a key role in pelvic malignancies' management. Excellent outcomes have been reported on its association with chemotherapy for the treatment of the anal carcinoma. Despite that, the combined use of chemo- and radiotherapy and the high doses administered seem to be strongly associated with early and late onset side effects. METHODS: We reported a case of a 72 years old woman, affected by anal squamous cell carcinoma. She underwent chemotherapy, and then radiotherapy, with good results. RESULTS: During a regular MR control, the patient developed anaphylactic reaction to Gadolinium, and after that a rectosigmoid ischemia with total necrosis of the posterior rectal wall was diagnosed and surgically treated with Hartmann procedure. CONCLUSION: In our case we faced with the rapid and severe degeneration of pelvic anatomy determined by the sum of vascular alterations following hypovolemic shock and pelvic tissues alteration after radiotherapy. It seems essential not to underestimate the exponential outcome of a similar unusual combination of events. KEY WORDS: Anal carcinoma, Hypovolemic shock, Pelvic radiotherapy, Rectal necrosis.


Assuntos
Anafilaxia/induzido quimicamente , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/terapia , Carcinoma/radioterapia , Quimiorradioterapia/efeitos adversos , Colo Sigmoide/irrigação sanguínea , Meios de Contraste/efeitos adversos , Gadolínio/efeitos adversos , Isquemia/etiologia , Protectomia , Lesões por Radiação/etiologia , Fístula Retovaginal/etiologia , Reto/irrigação sanguínea , Choque/etiologia , Idoso , Anafilaxia/complicações , Carcinoma/tratamento farmacológico , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/efeitos da radiação , Colo Sigmoide/cirurgia , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Parada Cardíaca/etiologia , Humanos , Isquemia/patologia , Isquemia/cirurgia , Mitomicina/administração & dosagem , Necrose , Fístula Retovaginal/diagnóstico por imagem , Fístula Retovaginal/cirurgia , Reto/diagnóstico por imagem , Reto/efeitos da radiação , Reto/cirurgia , Tomografia Computadorizada por Raios X
15.
Surg Laparosc Endosc Percutan Tech ; 29(4): e53-e56, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259866

RESUMO

The formation of an advancement rectal flap could be technically demanding in the presence of high perianal of rectovaginal fistula, and the outcomes could be frustrated by the inadequate view, bleeding and a poor exposure through the standard transanal approach. The application of the transanal minimally invasive surgery (TAMIS) to the advancement rectal flap procedure could overcome these difficulties. In the lithotomy position, a partial fistulectomy was performed and the internal opening was closed. A full-thickness flap was mobilized initially through the classic transanal approach. Subsequently, the TAMIS port was inserted and the mobilization of the flap was carried on proximally for as long as required. The laparoscopic visualization allowed a perfect view, a proper orientation of the flap and accurate hemostasis. The TAMIS-flap procedure seems a promising technique to perform a long advancement rectal flap to treat high perianal or rectovaginal fistulae (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A208).


Assuntos
Segurança do Paciente , Fístula Retal/cirurgia , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos/transplante , Cirurgia Endoscópica Transanal/métodos , Idoso , Feminino , Sobrevivência de Enxerto , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Posicionamento do Paciente , Prognóstico , Fístula Retal/diagnóstico , Amostragem , Resultado do Tratamento
16.
Colorectal Dis ; 21(12): 1421-1428, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31260184

RESUMO

AIM: The percentage recurrence after any surgical treatment for low rectovaginal fistula (LRVF) is unacceptably high. The aim of this study was to evaluate the short- and long-term results of the Martius procedure in a carefully selected series of patients with a LRVF of at least 1 cm diameter who had had at least two previous surgeries or in the presence of chronically inflamed local tissues. METHOD: Between January 2009 and April 2017, 24 patients with the abovementioned features were prospectively included in this study. Success was defined both as the absence of any subjective symptoms and the fistula, as confirmed by evaluation under anaesthesia. Postoperative complications were assessed using the Clavien-Dindo classification. Quality of life (SF-12 score), quality of sexual life [Female Sexual Function Index (FSFI) score] and continence [Cleveland Clinic Incontinence Score (CCIS)] were also determined pre- and postoperatively. RESULTS: The mean follow-up was 42 ± 29 months (range 3-101 months). The overall success rate was 91.3% (22/24 patients). The median operation time was 50 min (range 45-70 min), and the median hospital stay was 3.5 days (range 3-5 days). No major complications occurred. Pre- and postoperative CCIS did not differ [1 (range 0-3.5)]. The postoperative SF-12 score improved both in terms of the physical (33.6 ± 7.2 vs 50.8 ± 7.8; P < 0.001) and mental (32.6 ± 6.7 vs 56.3 ± 7.8; P < 0.001) components. FSFI improved from 19.5 ± 6.6 to 24.4 ± 6.3 (P < 0.001). CONCLUSION: The Martius procedure should be considered as the first-line method of treatment in carefully selected cases of LRVF.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recidiva , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
17.
Colorectal Dis ; 21(12): 1429-1437, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31245912

RESUMO

AIM: Successful treatment of complex rectovaginal fistulas (RVFs) continues to be a surgical challenge. Interposition of well-perfused tissue, such as gracilis muscle, is one treatment option. The aim of this study was to investigate the operative results, sexual function and quality of life after gracilis muscle transposition (GMT) in the authors' own group of patients. METHOD: The study included 19 women with RVF (mean age 48 years). The postoperative outcome was evaluated by a questionnaire and clinical examination. RESULTS: The postoperative follow-up period was 7 months to 3.5 years (mean 23 months). GMT led to primary healing of RVF in 10 (53%) patients. Recurrences were observed in nine (47%) patients with RVF, in four (44%) of whom healing was achieved as a result of further interventions. Following GMT, two complications (abscess formation) requiring revision occurred. Although 42% of the patients reported certain limitations following muscle removal, GMT is a procedure that has a positive influence on the healing rate (74%), quality of life, continence and patient satisfaction. CONCLUSION: GMT is a procedure that allows healing in the majority of patients with RVFs, and it should be considered especially in patients with recurrent fistulas, in whom a correlation between decreasing healing rates and the number of previous operations has been demonstrated.


Assuntos
Músculo Grácil/transplante , Complicações Pós-Operatórias/epidemiologia , Fístula Retovaginal/cirurgia , Disfunções Sexuais Fisiológicas/epidemiologia , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Qualidade de Vida , Recidiva , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento
19.
ANZ J Surg ; 89(5): E179-E183, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30968540

RESUMO

BACKGROUND: Delayed coloanal anastomosis (DCAA) may be used in patients with complex rectal conditions, such as chronic pelvic sepsis, low recto-vaginal and recto-vesical fistula; however, limited data are available. The aim is to report the morbidity and functional results of DCAA in redo rectal surgery. METHODS: All patients undergoing DCAA between January 2014 and August 2017 were retrospectively included. Success was defined as a functional anastomosis without stoma, evaluated using the Low Anterior Resection Syndrome (LARS) score and the Gastrointestinal Quality of Life Index (GIQLI) functional assessment tools. RESULTS: Of the 72 redo pelvic surgeries, 29 (40.3%) DCAA were performed over a 4-year period. Indications for redo resection were chronic pelvic sepsis (n = 13, 44.8%), recto-vaginal fistula (n = 11, 37.9%) and recto-vesical fistula (n = 5, 17.2%). Mean interval period between the two procedures was 14 ± 3 days (8-21). Global major morbidity (Clavien-Dindo III or IV) was seen in six patients (20.7%). Stoma closure was feasible for 22 (75.9%) patients after a median period of 78 days (interquartile range 61-98). The 6-month success rate was 79.3%. Mean LARS was 28.8 ± 10.2 (3-41) (minor LARS) for 18 patients with no stoma at the end of follow-up. LARS score was significantly better with a follow-up >2 years (23.3 ± 12.2 versus 32.3 ± 7.9), P = 0.074. Mean GIQLI score was 79.2 ± 14.3 (48-98). CONCLUSIONS: Transanal colonic pull through with delayed anastomosis for redo-surgery in complex pelvic situations had low morbidity and avoided a permanent stoma in three out of four patients with an acceptable quality of life.


Assuntos
Canal Anal/cirurgia , Colo/cirurgia , Doença Inflamatória Pélvica/cirurgia , Protectomia/efeitos adversos , Fístula Retovaginal/cirurgia , Tempo para o Tratamento , Adulto , Idoso , Anastomose Cirúrgica/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Protectomia/métodos , Qualidade de Vida , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Fístula Retovaginal/etiologia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Sepse/etiologia , Sepse/cirurgia , Estomas Cirúrgicos , Resultado do Tratamento
20.
J Vet Med Sci ; 81(5): 703-706, 2019 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-30944273

RESUMO

We describe the successful surgical repair of third-degree perineal lacerations with rectovestibular fistulae in four cases using the single-stage modified Aanes method with purse-string suture of the vaginal vestibule and rectum. Fistulae formation and dehiscence of the repair were not observed after surgery. Two cows had five calves and one cow had four calves after surgery. The pregnant cows delivered normally. Additionally, there was no dehiscence of the suture line during the subsequent parturition. The breeding and fertility results obtained after the surgery are presented. According to the results of the present study, the modified Aanes method for the repair of third-degree perineal lacerations with rectovestibular fistulae appears to have a good prognosis for fertility following surgery in cows.


Assuntos
Doenças dos Bovinos/cirurgia , Complicações do Trabalho de Parto/veterinária , Períneo/lesões , Fístula Retovaginal/veterinária , Animais , Bovinos , Feminino , Fertilidade , Complicações do Trabalho de Parto/cirurgia , Períneo/cirurgia , Gravidez , Fístula Retovaginal/cirurgia
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