1
|
Muller O, Labiad C, Frontali A, Giacca M, Monsinjon M, Panis Y. What is the best surgical option after failure of graciloplasty in patients with recurrent rectovaginal fistula? A study of 19 consecutive patients. Tech Coloproctol 2023; 27:453-458. [PMID: 36574114 DOI: 10.1007/s10151-022-02742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Management of recurrent rectovaginal fistula (rRVF) remains challenging despite the good results of graciloplasty reported in the literature. However, little is known about how to avoid a permanent stoma if graciloplasty fails. The aim of our study was to report the management of rRVF after failure of graciloplasty. METHODS A retrospective study was performed on consecutive patients with rRVF after failure of graciloplasty treated at our institution in January 2005-December 2021. RESULTS There were 19 patients, with a median age at graciloplasty of 39 years (range 25-64 years). Etiologies of RVF were Crohn's disease (CD) (n = 10), postoperative (n = 5), post-obstetrical (n = 3), and unknown (n = 1). After failure of graciloplasty, 45 new procedures were performed, all of them with a covering stoma: trans-anal repairs (n = 31), delayed colo-anal anastomosis (DCAA) (n = 4), biological mesh interposition (n = 3), second graciloplasty (n = 3), stoma only (n = 2) and redo ileal pouch-anal anastomosis (IPAA) (n = 2). One patient was not re-operated on and instead treated medically for CD. After a mean follow-up of 63 ± 49 months, success (i.e., absence of stoma or RVF) was obtained in 11 patients (58%): 4/4 DCAA (100%), 5/31 after local repair (16%), 1 after stoma creation alone (50%) and 1 after redo IPAA (50%). Second graciloplasty and biologic mesh interposition all failed. All 8 patients with failed intervention had CD. CONCLUSIONS In cases of rRVF after failed graciloplasty, reoperation is possible, although the chance of success is relatively low. The best results were obtained with DCAA. CD is a predictor of poor outcome.
Collapse
Affiliation(s)
- O Muller
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - C Labiad
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - A Frontali
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - M Giacca
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - M Monsinjon
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France.
| |
Collapse
|
2
|
Surgical treatment of deep-lying ano-/rectovaginal fistulas using a de-epithelialized “Singapore flap” (pudendal thigh flap). Eur Surg 2022. [DOI: 10.1007/s10353-022-00759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Summary
Background
Rectovaginal fistulas represent 5% of all anorectal fistulas. For affected women, this pathology is associated with a reduction in quality of life (QoL) and self-esteem. Most commonly used methods of surgical closure have high recurrence rates or permanent perineal complaints, which in turn lead to negative effects on QoL and self-esteem. A fistula closure, using the “de-epithelialized Singapore flap” (SF), can be a good alternative therapy strategy.
Method
Our retrospective case series processes the long-term results of seven patients who were operated on for ano-/rectovaginal fistula using the SF. All patients underwent surgery at the University Hospital Graz, between May 2012 and July 2015. The data of the surgical follow-up examinations were collected and an additional telephone survey was carried out. The procedure is presented based on a structured description. All procedures were performed jointly by the Department of General Surgery and the Department of Plastic Surgery.
Results
The average age of the seven patients was 46.14 years (23–72 a). Five patients had a total of 12 previous operations with frustrating results. Of the seven patients treated, six had a permanent fistula closure (85.7%). The results of the telephone survey (n = 6) showed a high level of patient satisfaction (100%), and an improvement in QoL (83.3%), through our surgical method. In our cohort, neither urinary nor fecal incontinence occurred.
Conclusion
The treatment of an ano-/rectovaginal fistula using the “de-epithelialized pudendal thigh flap” (Singapore flap) is a promising treatment alternative. In particular, patients who have had previous proctological interventions show a benefit from this procedure.
Collapse
|
3
|
Söderqvist EV, Cashin PH, Graf W. Surgical treatment of rectovaginal fistula-predictors of outcome and effects on quality of life. Int J Colorectal Dis 2022; 37:1699-1707. [PMID: 35779081 PMCID: PMC9262790 DOI: 10.1007/s00384-022-04206-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the results after rectovaginal fistula (RVF) repair and find predictors of outcome. Primary objective was fistula healing. Secondary outcomes were morbidity and patient health-related quality of life (HRQoL). METHOD An observational study of 55 women who underwent RVF repair including both local procedures and tissue transposition 2003-2018 was performed. Baseline patient and fistula characteristics were registered, combined with a prospective HRQoL follow-up and a general questionnaire describing fistula symptoms. RESULTS Healing rate after index surgery was 25.5% (n = 14) but the final healing rate was 67.3% (n = 37). Comparing the etiologies, traumatic fistulas (iatrogenic and obstetric) had the highest healing rates after index surgery (n = 11, 45.9%) and after repeated operations at final follow-up (n = 22, 91.7%) compared with fistulas of inflammatory fistulas (Crohn's disease, cryptoglandular infection, and anastomotic leakage) that had inferior healing rates after both index surgery (n = 7, 7.1%) and at final follow-up (n = 13, 46.4%). Fistulas of the category others (radiation damage and unknown etiology) included a small amount of patients with intermediate results at both index surgery (n = 1, 33.3%) and healing rate at last follow-up (n = 2, 66.7%). The differences were statistically significant for both index surgery (p = 0.004) and at final follow-up (p = 0.001). Unhealed patients scored lower than both healed patients and the normal population in 6/8 Rand-36 domains, but the differences were not statistically significant. CONCLUSIONS Most traumatic rectovaginal fistulas closed after repeated surgery whereas inflammatory fistulas had a poor prognosis. Low healing rates after local repairs suggest that tissue transfer might be indicated more early in the treatment process. Unhealed fistulas were associated with reduced quality of life. Trial registration Clinicaltrials.gov No. NCT05006586.
Collapse
Affiliation(s)
- Erik V. Söderqvist
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden
| | - Peter H. Cashin
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden
| | - Wilhelm Graf
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden
| |
Collapse
|
4
|
Grott M, Rickert A, Hetjens S, Kienle P. Clinical outcome and quality of life after gracilis muscle transposition for fistula closure over a 10-year period. Int J Colorectal Dis 2021; 36:569-580. [PMID: 33386945 DOI: 10.1007/s00384-020-03825-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options have failed. There is little evidence on the success rate of this procedure in the long term. METHODS This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function. RESULTS Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (n = 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months). CONCLUSION GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.
Collapse
Affiliation(s)
- M Grott
- Department of Thoracic Surgery, Thoraxklinik Heidelberg University, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - A Rickert
- Department of Surgery, St. Josefskrankenhaus Heidelberg, Akademisches Lehrkrankenhaus der Medizinischen Fakultät Mannheim der Universität Heidelberg, Landhausstraße 25, 69115, Heidelberg, Germany
| | - S Hetjens
- Department for Medical Statistics and Biomathematics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberg University, Bassermannstraße 1, 68165, Mannheim, Germany.
| |
Collapse
|
5
|
Michot N, Guilbaud T, Le Nail LR, Ouaissi M. Chronic pelvic sepsis with pubic bone osteitis treated with double graciloplasty. Tech Coloproctol 2020; 24:211. [PMID: 31939045 DOI: 10.1007/s10151-019-02109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/31/2019] [Indexed: 11/24/2022]
Affiliation(s)
- N Michot
- Department of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, CHRU Trouseau, Tours, France
| | - T Guilbaud
- Department of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, CHRU Trouseau, Tours, France
| | - L R Le Nail
- Department of Traumatology and Orthopedics, Trousseau Hospital, University of Tours, Tours, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, and Hepatic Surgery, and Hepatic Transplantation, Trousseau Hospital, CHRU Trouseau, Tours, France.
| |
Collapse
|
6
|
Kersting S, Athanasiadis CJ, Jung KP, Berg E. Operative results, sexual function and quality of life after gracilis muscle transposition in complex rectovaginal fistulas. Colorectal Dis 2019; 21:1429-1437. [PMID: 31245912 DOI: 10.1111/codi.14741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- S Kersting
- Department of General Surgery, Katharinen-Hospital Unna, Unna, Germany
| | - C-J Athanasiadis
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - K-P Jung
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - E Berg
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| |
Collapse
|
7
|
Madhoun MF, Hayat M, Ali IA. Higher dose of simethicone decreases colonic bubbles and increases prep tolerance and quality of bowel prep: Meta-analysis of randomized controlled trials. World J Meta-Anal 2019; 7:110-119. [DOI: 10.13105/wjma.v7.i3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antifoaming agents, such as simethicone, may facilitate mucosal inspection during colonoscopy. However, conflicting results have been reported with regard to the impact of simethicone on quality of bowel preparation and adenoma detection rate (ADR).
AIM To perform a meta-analysis of trials that have compared simethicone vs placebo during colonoscopy.
METHODS A reproducible literature search of multiple medical databases yielded eleven studies (n = 2605) for inclusion. Studies were compared for quality of bowel preparation, bubbles quality, ADR, and tolerability. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted by both fixed-effects and random-effects models. Relative risk (RR) estimates with a 95% confidence interval (CI) were calculated. Heterogeneity was assessed by I-squared index (I2) statistics.
RESULTS Patients’ demographic characteristics were comparable in all studies. Of the 2605 patients, 1300 were in the simethicone group, whereas 1305 were in the placebo group. Inadequate bowel preparation was much lower in the simethicone group than in the placebo group [13% vs 24.6%; RR = 0.51 (0.31-0.82); P < 0.0001]. The placebo group was more likely to have significant colonic bubbles than was the simethicone group [35% vs 8%; RR = 1.49 (1.25-1.76); P = 0.0001]. Use of simethicone resulted in a slight, statistically significant increase in ADR compared with the placebo group [26.6% vs 21.6%, RR = 1.07 (1.01-1.13); P = 0.02]. Higher doses of simethicone (> 478 mg) were more likely to result in significant reduction of inadequate bowel preparation, colonic bubbles, and to improve ADR.
CONCLUSION Adding simethicone improved the quality of bowel preparation, visualization, tolerability, and, eventually, ADR.
Collapse
Affiliation(s)
- Mohammad F Madhoun
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
| | - Maham Hayat
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
| | - Ijlal Akbar Ali
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
- Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
| |
Collapse
|
8
|
Treatment Efficacy of Different Surgical Procedures for Postoperative Residual Rectourethral Fistula Following Anoplasty. Int Surg 2017. [DOI: 10.9738/intsurg-d-17-00092r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/Purpose:
This study summarizes the surgical treatment options and their clinical efficacy for postoperative residual rectourethral fistula following anoplasty in patients treated in our department from July 2005 to July 2012.
Methods:
For 38 cases of postoperative residual rectourethral fistula following anoplasty, according to differences in anal appearance and functionality, either an anterior sagittal or a posterior sagittal surgical rectourethral fistula repair procedure was performed.
Results:
The residual rectourethral fistula following anoplasty was an obvious tube-like structure with a length of 0.9 ± 0.4 cm. Healing after the 1-stage operation was achieved in 37 cases. Among these cases, 35 were followed up and showed no urethral stricture and no diverticulum. The clinical score for anal function was excellent in 31 cases and good in 4 cases, with significant differences compared with the scores before surgery (P < 0.05). The respective operative times for the 2 surgical procedures were 74.6 ± 10.1 minutes and 105.6 ± 14.6 minutes (P < 0.05).
Conclusions:
The appropriate choice of surgical procedure was dependent on the patients' anal appearance and functionality. Posterior sagittal anorectoplasty was suitable in cases with a severely disordered perineal appearance, and it was a relatively difficult operation. In contrast, anterior sagittal anorectoplasty was best applied in patients with minor alteration in perineal appearance, and it had a clear surgical field and was easy to perform. In this study, the repair of cases of residual rectourethral fistula following anoplasty using anterior sagittal or posterior sagittal anorectoplasty showed high success rates, and anal function was significantly improved.
Collapse
|
9
|
Abstract
Radiotherapy not only plays a pivotal role in the cancer care pathways of many patients with pelvic malignancies, but can also lead to significant injury of normal tissue in the radiation field (pelvic radiation disease) that is sometimes as challenging to treat as the neoplasms themselves. Acute symptoms are usually self-limited and respond to medical therapy. Chronic symptoms often require operative intervention that is made hazardous by hostile surgical planes and unforgiving tissues. Management of these challenging patients is best guided by the utmost caution and humility.
Collapse
Affiliation(s)
- Jean H Ashburn
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew F Kalady
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
10
|
Selph JP, Madden-Fuentes R, Peterson AC, Webster GD, Lentz AC. Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair. Urology 2015; 86:608-12. [DOI: 10.1016/j.urology.2015.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
|
11
|
Cerdán Santacruz C, Cerdán Miguel J. Acquired recto-uretral fistulas: etiopathogenesis, diagnosis and therapeutic options. Cir Esp 2014; 93:137-46. [PMID: 25467973 DOI: 10.1016/j.ciresp.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/05/2014] [Indexed: 01/26/2023]
Abstract
Rectouretral fistulas are a rare disease, but represent an important problem for the patient that suffers them and a challenge for the urologist and colorectal surgeon who has to manage them. A wide review has been performed focusing on etiopathogenic factors, diagnostic and therapeutic options including the analysis of different surgical techniques. PubMed, MEDLINE y EMBASE medical database were searched up to September 2014.
Collapse
|
12
|
de Weerd L, Weum S, Norderval S. Novel treatment for recalcitrant rectovaginal fistulas: fat injection. Int Urogynecol J 2014; 26:139-44. [PMID: 25199495 DOI: 10.1007/s00192-014-2497-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The treatment of recurrent rectovaginal fistula (RVF) is a challenge for the surgeon. Within plastic surgery fat harvesting and subsequent transplantation by injection is an established method for soft tissue augmentation. We hypothesized whether soft tissue augmentation by transperineal injection of autologous fat could stimulate fistula healing in women with recalcitrant RVF. MATERIALS AND METHODS Six patients with a recalcitrant RVF, 4 due to obstetric injury and 2 associated with Crohn's disease, were included in the pilot study. The fat graft from the lower abdomen was injected transperineally around the fistula tract. At the end of the injection procedure the fistula tract was transected transversely. RESULTS In 1 patient the fistula healed after a single treatment, while the other 5 required two treatments with a 6-week interval. In the patients with an RVF due to obstetric injury no recurrence occurred during follow-up, mean 41 months (range 4-53). In the 2 patients with Crohn's disease a new fistula developed after 23 and 25 months respectively. CONCLUSION We describe fat injection as a new and promising method for the treatment of a recalcitrant RVF where previous attempts had failed to heal the fistula. This method does not include wide dissection, thereby reducing the risk of injury to important neurovascular structures. The method is minimally invasive and causes minimal donor site morbidity. More advanced techniques can still be used in cases of recurrence.
Collapse
Affiliation(s)
- L de Weerd
- Department of Plastic Surgery and Hand Surgery, University Hospital North Norway, Tromsø, Norway,
| | | | | |
Collapse
|
13
|
Treatment of recurrent rectovaginal/pouch-vaginal fistulas by gracilis muscle transposition – a single center experience. J Visc Surg 2013; 150:379-82. [DOI: 10.1016/j.jviscsurg.2013.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
14
|
Abdou AH, Troja A, Raab HR, Antolovic D. Feasibility of Gracilis Muscle Flap Interposition for Management of Recurrent Rectovesical/Rectourethral Fistulas: A Single Centre Expertise. Visc Med 2013. [DOI: 10.1159/000354775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background: </i></b>Recurrent rectovesical fistulas are a serious burden for the affected patient. Depending on the size and location of the fistula, the underlying disease as well as the preceding therapies, a definitive surgical treatment of the fistula should be the main goal. We analysed the technique of the transposition of the gracilis muscle as a therapeutical option. <b><i>Methods: </i></b>We analysed data from 3 male patients who were diagnosed with a recurrent rectovesical fistula and were treated by the transposition of the gracilis muscle in the surgical department of Klinikum Oldenburg. <b><i>Results: </i></b>All 3 patients suffered from prostate cancer and were already treated by a different surgical approach while one patient had a second recurrence. Complications arose in two cases in the form of fistula recurrence. <b><i>Conclusion: </i></b>Our study has shown that the interposition of the gracilis muscle provides an option to treat rectovesical fistulas.
Collapse
|
15
|
Ommer A, Herold A, Berg E, Fürst A, Schiedeck T, Sailer M. German S3-Guideline: rectovaginal fistula. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2012; 10:Doc15. [PMID: 23255878 PMCID: PMC3525883 DOI: 10.3205/000166] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Indexed: 12/12/2022]
Abstract
Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease. Methods: A systematic review of the literature was undertaken. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient. Conclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature.
Collapse
|
16
|
|
17
|
Pescatori M. Rectovaginal Fistulae. PREVENTION AND TREATMENT OF COMPLICATIONS IN PROCTOLOGICAL SURGERY 2012:85-97. [DOI: 10.1007/978-88-470-2077-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
18
|
D'Ambrosio G, Paganini AM, Guerrieri M, Barchetti L, Lezoche G, Fabiani B, Lezoche E. Minimally invasive treatment of rectovaginal fistula. Surg Endosc 2011; 26:546-50. [PMID: 22083318 DOI: 10.1007/s00464-011-1917-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 08/22/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rectovaginal fistulas (RVFs) are a rare surgical condition. Their treatment is extremely difficult, and no standard surgical technique is accepted worldwide. This report describes a new approach using transanal endoscopic microsurgery (TEM) to treat RVFs. METHODS A retrospective review of 13 patients who underwent repair of rectovaginal fistula using TEM between 2001 and 2008 was undertaken. The surgical technique is widely described, and the advantages of the endorectal approach are noted. RESULTS The median follow-up period was 25 months, and the median age of the patients was 44 years (range, 25-70 years). The mean operative time was 130 min (range, 90-150 min), and the hospital stay was 5 days (range, 3-8 days). One patient experienced recurrence. This patient underwent reoperation with TEM and experienced re-recurrence. Two patients had minor complications (hematoma of the septum and abscess of the septum), which were treated with medical therapy. For two patients, a moderate sphincter hypotonia was registered. CONCLUSIONS A new technique for treating RVFs using TEM is presented. The authors strongly recommend this approach that avoids any incision of the perineal area, which is very painful and can damage sphincter functions.
Collapse
Affiliation(s)
- Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation Paride Stefanini, University of Rome La Sapienza, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
19
|
Chun L, Abbas MA. Rectourethral fistula following laparoscopic radical prostatectomy. Tech Coloproctol 2011; 15:297-300. [PMID: 21720888 DOI: 10.1007/s10151-011-0710-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the outcome of rectourethral fistula sustained during laparoscopic radical prostatectomy. METHODS A retrospective chart review of all cases managed at a tertiary referral center. Data abstracted included demographics, presenting symptoms, additional interventions, healing, and long-term functional outcome. RESULTS Between 2004 and 2009, 10 patients were treated for rectourethral fistula following laparoscopic radical prostatectomy. Mean age was 60 years. Two patients were converted to open prostatectomy for primary repair of the rectal laceration without fecal diversion. The remaining 8 patients (80%) had unrecognized injury at the time of prostatectomy and presented postoperatively. Mean time from radical prostatectomy to presentation with fistula symptoms was 9.5 days. Seven patients (70%) required 1 or more operations to treat or control the symptoms of the rectourethral fistula (median 2.3, mean 2, range 1-4 operations). Three patients (30%) required colostomy within 1 month of radical prostatectomy due to severity of symptoms. Spontaneous healing of the fistula was noted in 6 patients (60%) following diversion (urinary ± fecal diversion), and a minority of patients (30%) required an operation to close the fistula. One patient (10%) required cystectomy for positive margins. During a mean follow-up of 27 months, no recurrent fistula was observed in any of the patients. All patients had normal anal continence, but the majority of patients were incontinent of urine. CONCLUSIONS Patients who develop a rectourethral fistula following laparoscopic radical prostatectomy often require additional operations for symptoms control and/or healing of the fistula. Urinary continence is affected in the majority of patients.
Collapse
Affiliation(s)
- L Chun
- Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, Los Angeles, CA 90027, USA
| | | |
Collapse
|
20
|
Pigalarga R, Patel NM, Rezac C. Transanal endoscopic microsurgery-assisted rectal advancement flap is a viable option for iatrogenic rectourethral fistula repair: a case report. Tech Coloproctol 2011; 15:209-11. [PMID: 21431386 DOI: 10.1007/s10151-011-0679-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 02/16/2011] [Indexed: 11/29/2022]
Abstract
Rectourethral fistula (RUF) is a relatively rare complication of radical prostatectomy, but is extremely difficult to treat. Multiple surgical approaches have been described for definitive treatment, but to date none of them have been determined to be the gold standard, either due to a high recurrence rate of the condition or due to the morbidity associated with the procedure. In this case report, we describe a successful repair of iatrogenic RUF through a multidisciplinary approach consisting of cystoscopy, urethral stent placement, colonoscopy, and TEM-assisted rectal advancement flap.
Collapse
Affiliation(s)
- R Pigalarga
- Department of General Surgery, Division of Colorectal Surgery, Robert Wood Johnson University Hospital/UMDNJ, New Brunswick, NJ, USA.
| | | | | |
Collapse
|
21
|
Pescatori M. Fistole retto-vaginali. PREVENZIONE E TRATTAMENTO DELLE COMPLICANZE IN CHIRURGIA PROCTOLOGICA 2011:85-97. [DOI: 10.1007/978-88-470-2062-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
22
|
Schwandner O, Fuerst A, Kunstreich K, Scherer R. Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 2009; 13:135-40. [PMID: 19484346 DOI: 10.1007/s10151-009-0470-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/06/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this prospective study was to analyse the efficacy of Surgisis mesh for closure of rectovaginal fistulas. Prospective data were collected from two centres. METHODS All patients with a rectovaginal fistula who underwent definitive surgery using Surgisis mesh were prospectively enrolled in this study. Inclusion criteria included a rectovaginal fistula in the lower two-thirds of the rectovaginal septum. Surgery was performed with a standardized technique including combined transrectal and transvaginal excision of the rectovaginal fistula with transvaginal placement of the mesh. Success was defined as closure of both internal and external (perianal and vaginal) openings, absence of drainage without further intervention, and no abscess formation. RESULTS Over a period of 16 months, a total of 21 mesh procedures were performed in two centres. The mean age of the patients was 47 years (18-59 years). Of the 21 patients, 18 (86%) had recurrent rectovaginal fistula, and the mean number of prior attempts was 2.3 (0-8). The majority of patients (nine) had Crohn's disease-associated fistula, followed by six with iatrogenic fistula, two with radiation-induced fistula, two with obstetric injury-induced fistula, and two with idiopathic fistula. The mesh procedure was performed under faecal diversion in eight patients (38%). The mean operative time was 38 min; no intraoperative morbidity occurred. Patients were discharged from hospital on day 4. After a mean follow-up of 12 months (range, 3-18 months), the overall success rate after primary mesh procedure was 71% (15/21; 6 patients had failure or recurrence). All patients with failure or recurrence were reoperated upon. Out of these six patients who were reoperated upon, four had definite healing (75%). Among the eight patients who had faecal diversion, four (50%) had reversal of their stoma. CONCLUSION The preliminary success rate for this innovative technique using Surgisis mesh for the closure of rectovaginal fistulas is promising. Further studies are needed to assess the definite role of this novel technique in comparison to traditional surgical procedures.
Collapse
Affiliation(s)
- O Schwandner
- Department of Surgery and Pelvic Floor Center, Caritas-Krankenhaus St. Josef, Regensburg, Germany.
| | | | | | | |
Collapse
|