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Kumar S, Chaudhary RK, Shah SS, Kumar D, Nepal P, Ojili V. Current update on the role of endoanal ultrasound: a primer for radiologists. Abdom Radiol (NY) 2024:10.1007/s00261-024-04300-0. [PMID: 38580791 DOI: 10.1007/s00261-024-04300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.
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Affiliation(s)
- Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR, 72205, USA.
| | - Ranjit K Chaudhary
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Samir S Shah
- Department of Radiology, Canpic Medical and Education Foundation, Pune, India
| | - Devendra Kumar
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Pankaj Nepal
- Department of Radiology, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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2
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Lussiez A, Nardos R, Lowry A. Rectovaginal Fistula Management in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:390-395. [PMID: 36111077 PMCID: PMC9470294 DOI: 10.1055/s-0042-1746187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rectovaginal fistula (RVF) is an abnormal connection between the rectum and vagina that affects women globally. In low- and middle-income countries (LMIC), RVF is most commonly due to obstetric complications such as prolonged labor or perineal tears, female genital mutilation and trauma such as sexual violence or iatrogenic surgical injuries. Women affected by this condition suffer from debilitating physical symptoms, social isolation, economic disempowerment, psychological trauma, low self-esteem, and loss of role fulfillment. Lack of accessible, high-quality, and effective healthcare is a major barrier to timely and safe obstetric care and to care for subsequent complications such as RVF. Additionally, social, cultural, financial, and systemic barriers put women at risk of acquiring fistula and contribute to delays in seeking and receiving care. Literature evaluating RVF repair in those able to access care offers limited information about management and outcomes. It is difficult to ascertain which surgical techniques are used. To reduce the burden of this often-preventable disease, appropriate investment in healthcare infrastructure to strengthen maternal care in LMICs is paramount. Furthermore, more standardized reporting of severity and treatment approach along with outcome data are critical to improving the quality of care for patients impacted by RVF.
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Affiliation(s)
- Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ann Lowry
- Division of Colon and Rectal Surgery, University of Minnesota, Bloomington, Minnesota
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3
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Schiff JP, Mintz R, Cohen AC, Huang Y, Thaker P, Massad LS, Powell M, Mutch D, Schwarz JK, Markovina ST, Grigsby PW. Overall survival in patients with FIGO stage IVA cervical cancer. Gynecol Oncol 2022; 166:292-299. [PMID: 35691754 DOI: 10.1016/j.ygyno.2022.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE FIGO stage IVA cervical cancer is a unique diagnosis that conveys a poor prognosis. Despite the use of PET/CT for staging, concurrent chemotherapy, and image-guided brachytherapy, overall survival (OS) in these patients is low. Treatment requires aggressive use of radiotherapy and chemotherapy. We report results of a prospective observational cohort study for patients with de novo stage IVA cervical cancer treated at a single institution. METHODS Patients with a new diagnosis of stage IVA cervical cancer treated at an academic institution between 1997 and 2020 were prospectively monitored. Staging was retroactively assigned using the 2018 FIGO staging system. All patients had a PET/CT prior to treatment and were treated with definitive intent radiotherapy with or without chemotherapy. The primary outcome of interest was OS. Secondary outcomes were local control, progression-free survival (PFS), and disease-specific survival (DSS). RESULTS 32 patients with de novo stage IVA cervical cancer were treated with definitive intent radiotherapy. Median follow-up time was 4.27 years (1.31-10.35). 22/32 (69%) of patients received brachytherapy as a part of their definitive treatment, and 28/32 (88%) received chemotherapy concurrently with radiotherapy. 14/32 (44%) of patients had no evidence of disease at last follow-up. The 5-year local control, PFS, DFS, and OS estimates were 79%, 49%, 53%, and 48%, respectively. On multivariate analysis, complete metabolic response was associated with a statistically significant improvement in PFS (HR = 0.256, 95% CI = 0.078-0.836, p = 0.024) and OS (HR = 0.273, 95% CI 0.081-0.919). CONCLUSIONS These data demonstrate a robust OS in patients with stage IVA cervical cancer when treated with definitive chemoradiotherapy.
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Affiliation(s)
- Joshua P Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Rachel Mintz
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Alexander C Cohen
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Yi Huang
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Premal Thaker
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Leslie S Massad
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Matthew Powell
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - David Mutch
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Julie K Schwarz
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Stephanie T Markovina
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Perry W Grigsby
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
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4
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Fukuda Y, Kudo Y, Saito M, Kaname T, Oota T, Shoji R. Expanding the PURA syndrome phenotype with manifestations in a Japanese female patient. Hum Genome Var 2022; 9:11. [PMID: 35440576 PMCID: PMC9019084 DOI: 10.1038/s41439-022-00189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/15/2023] Open
Abstract
We report on a 15-year-old Japanese female patient with hypotonia and global developmental delay from the neonatal period who was revealed to carry a known pathogenic PURA variant (NM_005859.5:c.697_699del, p.Phe233del) by whole-exome sequencing. She had previously unreported clinical features, including a rectovestibular fistula, extremely short stature, and underweight, expanding the known phenotype of PURA syndrome.
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Affiliation(s)
- Yuya Fukuda
- Department of Pediatrics, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | - Yoshimasa Kudo
- Department of Pediatrics, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | - Makoto Saito
- Department of Pediatrics, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | - Tadashi Kaname
- grid.63906.3a0000 0004 0377 2305Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tohru Oota
- grid.412021.40000 0004 1769 5590Research Institute of Health Sciences, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Reikichi Shoji
- Department of Pediatrics, Steel Memorial Muroran Hospital, Hokkaido, Japan
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Levy AD, Liu PS, Kim DH, Fowler KJ, Bharucha AE, Chang KJ, Cilenti E, Gage KL, Garcia EM, Kambadakone AR, Korngold EK, Marin D, Moreno C, Pietryga JA, Santillan CS, Weinstein S, Wexner SD, Carucci LR. ACR Appropriateness Criteria® Anorectal Disease. J Am Coll Radiol 2021; 18:S268-S282. [PMID: 34794588 DOI: 10.1016/j.jacr.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/06/2023]
Abstract
This review summarizes the relevant literature for the selection of the initial imaging in 4 clinical scenarios in patients with suspected inflammatory disease or postoperative complication of the anorectum. These clinical scenarios include suspected perianal fistula or abscess; rectovesicular or rectovaginal fistula; proctitis or pouchitis; and suspected complication following proctectomy, coloproctectomy, or colectomy with a pouch or other anastomosis. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of anorectal disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia.
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; and Founder, Advisory Board Quantix Bio
| | - Adil E Bharucha
- Chair of the Neurogastroenterology Section, Chair of Research Compliance Subcommittee, and Medical Director, Office of Clinical Trials, Mayo Clinic Rochester, Minnesota; and American Gastroenterological Association
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts
| | - Elizabeth Cilenti
- Medstar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; SECJNMMI Member-at-Large
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Taubman Museum of Art Board Member; and Past-President VA Rad Society
| | - Elena K Korngold
- Section Chief, Abdominal Imaging, Oregon Health and Science University, Portland, Oregon
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair ACR CTC Registry Committee; and Executive Council American Roentgen Ray Society
| | - Jason A Pietryga
- University of Alabama at Birmingham, Birmingham, Alabama; Associate Editor Hollow Organ GI
| | - Cynthia S Santillan
- Chief, Body Imaging Division and Vice-Chair, Clinical Operations for Radiology, University of California San Diego, San Diego, California
| | | | - Steven D Wexner
- Cleveland Clinic Florida, Weston, Florida; Editor-in-Chief, Surgery Journal; American College of Surgeons PAC Board; and Managing Member, Unique Surgical Innovations
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director of CT and MRI at VCU, Section Chief, Abdominal Imaging at VCU
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Miranda Varella Pereira G, Oliveira Brito LG, Slongo H, Carvalho de Araújo C, Benedito de Castro E, Teatin Juliato CR. Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review. J Low Genit Tract Dis 2021; 25:318-325. [PMID: 34542087 DOI: 10.1097/lgt.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries. METHODS Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary. RESULTS Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries. CONCLUSIONS Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.
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7
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Drumond DG, de Góis Speck NM, Chebli JMF, de Moraes Sarmento Condé C, Chebli LA, Pannain GD, Esperança SD. Treatment of Rectovaginal Fistula Using Fractionate CO 2 Vaginal Laser: A Case Series. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:622-629. [PMID: 34546109 DOI: 10.1089/photob.2020.4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Rectovaginal fistulas (RVFs) are abnormal tracts that connect the lower gastrointestinal tract with the vagina. They can result from obstetric trauma, infection, local surgeries, cancer, radiation damage, and Crohn's disease. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment. Objective: To report five cases of patients with RVF submitted to intravaginal CO2 fractional laser treatment, as a complementary and additional therapeutic option in this scenery. Materials and methods: Five laser sessions with monthly intervals followed by complete evaluation through clinical examination and magnetic resonance imaging of the pelvis were performed for all patients. Results: Three patients had complete resolution of symptoms after the end of planned vaginal laser sessions, whereas two patients reported significant improvement in symptoms. Four patients who had stopped having sex due to their condition admitted to resuming regular sexual activity. In addition, all five patients had closure of the fistulous track confirmed by pelvic MRI. No adverse events from vaginal laser therapy were reported by any of the patients. Conclusions: We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of RVF. It may potentially enable return to regular sexual activity. Future studies using this therapeutic strategy are needed to confirm the efficacy and safety of this method in this clinical setting. Clinical trial registration no.: CAAE 93673618.4.0000.5133.
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Affiliation(s)
- Denise Gasparetti Drumond
- Department of Surgery, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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8
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Wang P, Tong W, Wang Q. Combined transabdominal-transanal surgical approach for iatrogenic rectovaginal fistula: two case reports. Ann R Coll Surg Engl 2021; 104:e50-e53. [PMID: 34414795 DOI: 10.1308/rcsann.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal-transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal-transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.
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Affiliation(s)
- P Wang
- First Hospital of Jilin University, China
| | - W Tong
- First Hospital of Jilin University, China
| | - Q Wang
- First Hospital of Jilin University, China
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Hermann J, Cwaliński J, Banasiewicz T. Application of platelet-rich plasma in rectovaginal fistulas in the patients with ulcerative colitis. Langenbecks Arch Surg 2021; 407:429-433. [PMID: 34155543 PMCID: PMC8847300 DOI: 10.1007/s00423-021-02232-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/06/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC). PATIENTS AND METHODS Medical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients. RESULTS Complete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months. CONCLUSIONS The application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.
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Affiliation(s)
- Jacek Hermann
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland.
| | - Jarosław Cwaliński
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland
| | - Tomasz Banasiewicz
- Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, 49 Przybyszewski Str., 60-355, Poznań, Poland
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Rectovaginal fistulas, outcomes of various surgical repair and predictive factors of healing success. A retrospective cohort study of 40 cases. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Review of Malpractice Litigations Involving Vesicovaginal and Rectovaginal Fistulas Following Elective Hysterectomy for Benign Indications in the United States From 1970 to 2020. Female Pelvic Med Reconstr Surg 2021; 27:186-194. [PMID: 33620903 DOI: 10.1097/spv.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to review malpractice litigations involving vesicovaginal and rectovaginal fistulas after elective hysterectomy for benign indications in the United States and identify the most common themes in allegations by the plaintiffs and defenses by the defendants. METHODS Using the Lexis Nexis legal database, we searched for and reviewed all U.S. malpractice litigations pertinent to this question between 1970 and 2020. RESULTS Out of 82 cases that were identified and reviewed, 17 cases met our inclusion and exclusion criteria. These cases were decided between 1973 and 2019. Nine cases involved total abdominal hysterectomies, 1 involved total laparoscopic hysterectomy (TLH), 1 involved total vaginal hysterectomy (TVH), and the rest were not specified. Fifteen cases involved vesicovaginal fistulas and 2 involved rectovaginal fistulas. Three cases were ruled in favor of the plaintiffs, with monetary compensation ranging from $250,000 to $753,722 (approximately $364,120 to $1.8 million when adjusted for inflation), whereas 14 cases were ruled in favor of the defending surgeons. Common allegations were negligence in 15 cases and lack of informed consent in 2 cases. Factors that strengthened the defendants' arguments were thorough documentation, informed consent, and prompt referral to specialists. Intraoperative cystoscopy may have benefited in some cases. CONCLUSIONS Thorough documentation, informed consent, and prompt referral to specialists strengthened the defendants' legal arguments. Intraoperative cystoscopy may also be beneficial.
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12
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Perioperative Outcomes of Rectovaginal Fistula Repair Based on Surgical Approach: A National Contemporary Analysis. Female Pelvic Med Reconstr Surg 2021; 27:e342-e347. [PMID: 33181517 DOI: 10.1097/spv.0000000000000924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the perioperative outcomes of transvaginal/perineal and abdominal approaches to rectovaginal fistula (RVF) repair using a national multicenter cohort. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify women undergoing RVF repair from 2005 to 2016. Emergent cases and those with concomitant bowel diversion were excluded. Baseline patient demographics, procedure characteristics, 30-day postoperative complications, return to the operating room, and readmission were evaluated. Baseline characteristics were compared across surgical approach. Multivariable logistic regression models identified preoperative characteristics independently associated with postoperative complications. RESULTS A total of 2288 women underwent RVF repair: 1560 (68.2%) via transvaginal/perineal approach and 728 (31.8%) via abdominal approach. Patients undergoing transvaginal/perineal repair were significantly younger (median age, 46 years vs 63 years), with lower American Society for Anesthesiologist (ASA) scores, and less frequency of diabetes mellitus, dyspnea, severe chronic obstructive pulmonary disease, hypertension, disseminated cancer, and bleeding disorders (all P < 0.01). Those undergoing abdominal repair had higher rates of major complications (25.8% vs 8.7%), minor complications (13.5% vs 6.3%), and readmission (13.2% vs 7.8%). On multivariable analyses, ASA Class 3/4, disseminated cancer, and hematocrit <30% (P < 0.01) were associated with major complications in both groups. CONCLUSIONS Patients undergoing RVF repair via abdominal approach were older with more comorbidities and had higher postoperative complications rates, likely secondary to underlying differences in the treated populations. Irrespective of surgical approach, ASA class, disseminated cancer, and preoperative anemia were associated with higher postoperative morbidity. This may enhance preoperative counseling and allow for careful patient selection.
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13
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Stromal vascular fraction injection to treat intractable radiation-induced rectovaginal fistula. Arch Plast Surg 2021; 48:127-130. [PMID: 33503756 PMCID: PMC7861982 DOI: 10.5999/aps.2020.01718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/29/2020] [Indexed: 11/08/2022] Open
Abstract
Rectovaginal fistula, which can arise after an injury to the vaginal canal or rectum, is a troublesome obstacle for patients’ everyday life. In most cases, it can be covered with a local flap, but previous radiation therapy increases the recurrence rate, making it especially difficult to cure. As the application of stromal vascular fraction (SVF) obtained from enzymatically digested autologous adipose tissue has become increasingly common, several reports have advocated its effectiveness for the treatment of refractory wounds. In light of the angiogenic, regenerative characteristics of SVF, it was incorporated as a treatment option in two cases of rectovaginal fistula discussed here. As described in this report, irradiated rectovaginal fistulas in rectal cancer patients were successfully treated with SVF injection, and we suggest SVF as a feasible treatment option for cases of rectovaginal fistula that would otherwise be very difficult to cure.
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14
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Abdoli S, Masoumi SZ, Jenabi E. Investigation of Prevalence and Complications of Female Genital Circumcision: A Systematic and Meta-analytic Review Study. Curr Pediatr Rev 2021; 17:145-160. [PMID: 33655839 DOI: 10.2174/1573396317666210224143714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study was conducted to investigate the complications of circumcision and determine its prevalence in the studied areas. METHODS In this study, the electronic databases of Scopus, PubMed, SID, Web of Science and Magiran were selected to search the total population of observational studies published in Persian and English on the prevalence and circumcision complications in girls. The keywords searched for this purpose were as follows: female genital mutilation, Infibulations, Epidemiologic Methods, Clitorectomies, Female Circumcision, Clitorectomy, Clitoridectomy Complications, Prevalence, associated disease, coexistent conditions, and sequels associated with concomitant conditions, and coexistent disease and their Persian equivalent words. Prevalence estimates of all studies were pooled using a random-effects model at a confidence level of 95%. The bias in the published results of the studies and any reporting errors were examined using Begg and Egger's statistical tests. Out of 3756 studies, 45 articles were included in the study after excluding irrelevant and repetitive articles. RESULTS After reviewing the articles in this field, it was determined that female genital mutilation has sexual complications, problems during childbirth, physical and psychological complications. The prevalence of female genital circumcision in the world and Iran in the study areas was obtained using the random effect model, which was estimated to be 61% (95%, CI = 0.49, 0.73) and 61% (95%, CI = 0.52, 0.70), respectively. In other areas, the prevalence was reported to be close to zero. In total, among different countries of the world, of the 207,709 participants surveyed, 110,596 had undergone female genital circumcision (110,596 of 207,709). CONCLUSION The effects of female genital mutilation on girls are high and require government intervention in various countries.
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Affiliation(s)
- Sara Abdoli
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Mother and Child Care Research Center, Midwifery Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Nannyonga B, Singull M. Modelling allocation of resources in prevention and control of obstetric fistula in Ugandan women. PLoS One 2020; 15:e0238059. [PMID: 32911511 PMCID: PMC7482929 DOI: 10.1371/journal.pone.0238059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/07/2020] [Indexed: 11/18/2022] Open
Abstract
In spite of reliable and skilled healthcare resources, the prevalence rate of obstetric fistula in Uganda is high. The risk factors for obstetric fistula cut across due to high poverty rates and cultural barriers. The main objective of this study was to assess the impact of inability to access skilled healthcare at delivery and implications to the economy. The specific objective was to determine the best way of investment in getting women access to skilled healthcare before, during and after child birth. The question to be answered was whether it was more economical to invest in getting women access to skilled healthcare, or in expanding healthcare. The study was conducted using data from the Uganda Demographic Health Survey 2016. The data was from 18,506 women in the age group of 15-49 in 15 regions around the country. Results show that the highest investment in providing access to skilled healthcare is required when there are few skilled healthcare centres. On the other hand, if there is little investment in providing access to skilled healthcare during child birth, many skilled healthcare centres are required. Results show further that the minimum time taken to reduce fistula prevalence is attained when there are many women accessing skilled healthcare in the few equipped health centres. However, if there are many skilled healthcare centres but a few women treated for obstetric fistula, then it will take longer to reduce fistula prevalence. Fitting the model to data suggested that Uganda has a big backlog of women to treat for obstetric fistula as in all skilled healthcare centres, there were less women treated than expected. Although still under the expected figure, the benefit of these treatments for obstetric fistula is that for every one woman treated, 8 more would seek treatment for the condition. This would however cost the country a great deal in that the treatment funds would perhaps give more returns if diverted to outreach activities aimed to get women seek skilled healthcare during child birth.
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Affiliation(s)
- Betty Nannyonga
- Department of Mathematics, School of Physical Sciences, College of Natural Sciences, Makerere University, Kampala, Uganda
- Department of Mathematics, Mathematical Statistics, Linköping University, Linköping, Sweden
- * E-mail:
| | - Martin Singull
- Department of Mathematics, Mathematical Statistics, Linköping University, Linköping, Sweden
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16
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Sahnan K, Adegbola S, Iqbal N, Twum-Barima C, Reza L, Lung P, Warusavitarne J, Hart A, Tozer P. Managing non-IBD fistulising disease. Frontline Gastroenterol 2020; 12:524-534. [PMID: 34712471 PMCID: PMC8515280 DOI: 10.1136/flgastro-2019-101234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kapil Sahnan
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Samuel Adegbola
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Nusrat Iqbal
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Charlene Twum-Barima
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Lillian Reza
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Phillip Lung
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Janindra Warusavitarne
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Ailsa Hart
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
- IBD Unit, St Mark's Hospital, Harrow, UK
| | - Phil Tozer
- Department of Surgery and Cancer, Imperial College London, London, UK
- Robin Phillip’s Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
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17
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Huang MJ, Ye DX, Lin Y, Lu XR, Lin HM, Chi P, Huang Y. A nomogram for predicting rectovaginal fistula after low anterior resection for rectal cancer. Surg Today 2020; 50:1206-1212. [PMID: 32656700 DOI: 10.1007/s00595-020-02049-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/06/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Rectovaginal fistula (RVF) is a complicated and troublesome complication of low anterior resection (LAR) for rectal cancer. We aimed to investigate the risk factors for post-LAR RVF and develop a predictive nomogram. METHODS We performed a retrospective analysis of 821 female patients with rectal cancer who underwent LAR between October 2010 and October 2018. Logistic regression was performed to identify risk factors. A nomogram was developed to predict RVF. RESULTS The incidence of post-LAR RVF was 3.4% (28/821). A multivariate analysis showed that the preoperative serum hemoglobin level (OR 2.449, 95% CI 1.144-5.239), the distance between the tumor and anal verge (OR 4.158, 95% CI 1.392-12.418), surgical procedure (OR 2.369, 95% CI 1.117-5.027), hysterectomy (OR 2.996, 95% CI 1.106-8.833), and bilateral oophorectomy (OR 5.823, 95% CI 1.639-20.689) were significantly associated with the development of RVF. A nomogram was developed, which showed a C-index of 0.824 (95% CI 0.730-0.918) and an adjusted C-index of 0.790. CONCLUSION This study identified the preoperative serum hemoglobin level, the distance between the tumor and the anal verge, the type of surgical procedure, hysterectomy, and bilateral oophorectomy as predictors of post-LAR RVF. A nomogram was successfully developed. It could aid in the prediction of RVF in patients undergoing LAR.
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Affiliation(s)
- Ming-Jin Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Dao-Xiong Ye
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yu Lin
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xing-Rong Lu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Hui-Ming Lin
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
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Terry M, Ng MK, Ma T, Stein SL. Rectoperineal Fistula Repair Through Perineal Approach, Martius Flap, and House Advancement Flap. Cureus 2020; 12:e7001. [PMID: 32206465 PMCID: PMC7077134 DOI: 10.7759/cureus.7001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A rectoperineal fistula (RPF) is a relatively rare, non-life-threatening form of anorectal malformation that nevertheless causes significant physical discomfort, and remains technically challenging for surgeons to treat. We present a case of a 72-year-old female with a history of a recurrent perianal fistula with multiple approaches including endorectal advancement flap previously attempted. Our procedure involved laparoscopic loop ileostomy with transversus abdominis plane (TAP) block, and RPF repair through the perineal approach with primary repair involving Martius flap and house advancement flaps. The patient tolerated the procedure well with no known peri-operative complications and resolution of stool incontinence at subsequent post-operative visits, the first within a month of the procedure. This case was used to demonstrate and highlight the surgical technique of the RPF repair by Martius flap. Informed consent was obtained from the patient for video recording for educational purposes.
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Affiliation(s)
- Morgan Terry
- Surgery, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Mitchell K Ng
- Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Truong Ma
- Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Sharon L Stein
- Surgery: Colorectal Surgery, University Hospitals Cleveland Medical Center / University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, USA
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19
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Hanacek J, Havluj L, Drahonovsky J, Urbankova I, Krepelka P, Feyereisl J. Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis. Int Urogynecol J 2019; 30:2195-2198. [PMID: 31263915 DOI: 10.1007/s00192-019-04030-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Endometriosis is a gynecological condition characterized by endometrial tissue outside of the uterus. It affects up to 15% of women of reproductive age. In the case of bowel infiltration, about 90% of lesions are localized on the sigmoid colon or the rectum and may interfere with bowel function. Three surgical approaches are possible: (1) shaving technique, (2) discoid resection of the nodule, and (3) segmental resection with end-to-end anastomosis. A rectovaginal fistula is feared as a postoperative complication mainly in simultaneous resection of the vaginal and the rectosigmoid nodules. Its prevention is a two-step surgery (the first operation on the vagina and the second on the colon) or a preventive colostomy, both of which are often thought to be too invasive for a benign condition. Herein, we suggest a one-step surgery to prevent its development. METHODS In three women, a concomitant laparoscopic resection of the vaginal and rectosigmoid endometrial nodule was completed with interposition of a mesorectal flap. RESULTS All surgeries were uncomplicated with no rectovaginal fistula in the postoperative period. CONCLUSION In the hands of skilled surgeons, this one-step technique can be used to prevent rectovaginal fistula development.
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Affiliation(s)
- Jiri Hanacek
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic.
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Havluj
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of General Surgery, Third Faculty of Medicine and University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Jan Drahonovsky
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Iva Urbankova
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Krepelka
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Feyereisl
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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20
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Drumond DG, Chebli JMF, Speck NMDG, Chebli LA, Pannain GD, Esperança SD, Condé CDMS. Case Report: Treatment for Rectovaginal Fistula in Crohn's Disease Using Fractionate CO 2 Vaginal Laser with Anti-TNF Therapy. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:451-454. [PMID: 31210577 DOI: 10.1089/photob.2019.4643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Rectovaginal fistulas (RVFs) are defined as any connection between the anorectum and the vagina. They can have several causes, being Crohn's disease, the second leading cause of RVFs, responsible for ∼10% of the RVFs. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment. Objective: To report another therapeutic option, we describe the case of a patient with Crohn's disease and RVF refractory to anti-tumor necrosis factor (TNF) therapy, submitted to intravaginal CO2 fractional laser treatment. Materials and methods: Three laser sessions with monthly interval and analysis by clinical examination, sexual evaluation questionnaire, and magnetic resonance of the pelvis were performed. Results: We obtained an important improvement of the symptoms and of the dimension of the fistulous path. Conclusions: We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of vaginal fistula. Future studies using this therapeutic strategy are needed to confirm the efficacy of this method in this clinical setting.
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Affiliation(s)
- Denise Gasparetti Drumond
- 1 Department of Surgery, Faculty of Medicine, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
| | - Júlio Maria Fonseca Chebli
- 2 Department of Medical Clinic, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
| | | | - Liliana Andrade Chebli
- 4 Department of Medical Clinic, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
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21
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Do the Surgical Outcomes of Rectovaginal Fistula Repairs Differ for Obstetric and Nonobstetric Fistulas? A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg 2019; 25:36-40. [PMID: 28922306 DOI: 10.1097/spv.0000000000000484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Rectovaginal fistulas can occur from both obstetric and nonobstetric (eg, inflammatory bowel disease, iatrogenic, or traumatic) etiologies. Current data on factors contributing to rectovaginal repair success or failure are limited, making adequate patient counseling difficult. Our objective was to compare outcomes of transperineal rectovaginal fistula repair performed in a single referral center on women with obstetric and nonobstetric causes. METHODS We performed a retrospective cohort study of women who had a transperineal rectovaginal fistula repair performed by a urogynecologist at the University of Michigan from 2005 to 2015. Data were obtained by chart review and included demographics, medical comorbidities, fistula etiology, history of a prior fistula repair, failure of current repair, time to failure, and operative details. Repair failure was defined as fistula symptoms with presence of recurrent fistula on exam or imaging in the postoperative follow-up period. Comparisons between the obstetric and nonobstetric cohorts were performed using χ, Fisher exact, and Wilcoxon rank sum tests. Relative risks were calculated to identify predictors of failure. RESULTS Eighty-eight women were included-53 obstetric and 35 nonobstetric fistulas. The overall fistula repair failure rate was 22.7% (n = 20). Median follow-up was 157.0 days (range, 47.5-402.0). Of all the factors, only nonobstetric etiology was significantly associated with an increased risk of repair failure (relative risk, 3.53 [range, 1.50-8.32]; P = 0.004. CONCLUSIONS Nonobstetric rectovaginal fistulas have a nearly 4-fold increased risk of repair failure compared with obstetric fistulas. Our results will help surgeons adequately counsel patients on potential outcomes of surgical repair of obstetric versus nonobstetric rectovaginal fistulas.
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Knuttinen MG, Yi J, Magtibay P, Miller CT, Alzubaidi S, Naidu S, Oklu R, Kriegshauser JS, Mar WA. Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities. J Clin Med 2018; 7:jcm7040087. [PMID: 29690541 PMCID: PMC5920461 DOI: 10.3390/jcm7040087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022] Open
Abstract
Colovaginal and/or rectovaginal fistulas cause significant and distressing symptoms, including vaginitis, passage of flatus/feces through the vagina, and painful skin excoriation. These fistulas can be a challenging condition to treat. Although most fistulas can be treated with surgical repair, for those patients who are not operative candidates, limited options remain. As minimally-invasive interventional techniques have evolved, the possibility of fistula occlusion has enriched the therapeutic armamentarium for the treatment of these complex patients. In order to offer optimal treatment options to these patients, it is important to understand the imaging and anatomical features which may appropriately guide the surgeon and/or interventional radiologist during pre-procedural planning.
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Affiliation(s)
| | - Johnny Yi
- Mayo Clinic Arizona; Phoenix, AZ 85054 USA.
| | | | | | | | | | - Rahmi Oklu
- Mayo Clinic Arizona; Phoenix, AZ 85054 USA.
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23
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Tankel J, Yellineck S, Reissman P. Fistulation between a colonic J-Pouch and the upper vagina in an irradiated pelvis: a rare complication following low anterior resection with colonic J-pouch anal anastomosis for rectal cancer. BMJ Case Rep 2018; 2018:bcr-2017-222251. [PMID: 29453211 DOI: 10.1136/bcr-2017-222251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Formation of a colonic J-pouch with anastomosis to the rectal stump is an accepted form of reconstruction after low anterior resection (LAR) for rectal carcinoma. It is thought this can help prevent the onset of LAR syndrome as well as improve the quality of life in the first two years following surgery. Rectovaginal fistulation is a recognised complication of this form of surgery usually occurring because of technical failure leading to inclusion of the vaginal wall into the stapled anastomosis. We present an as of yet unreported case of fistulation between the upper horizontal staple line of a colonic J-pouch-the tip of the 'J'-which was formed extracorporeally with the posterior vaginal fornix. We postulate that pelvic irradiation was partly a causative factor alongside subsequent mechanical irritation. Ultimately, surgical intervention was required, following which the patient made a full recovery. Interposition of omentum may prevent this problem.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shlomo Yellineck
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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24
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Schloericke E, Zimmermann M, Benecke C, Laubert T, Meyer R, Bruch HP, Bouchard R, Keck T, Hoffmann M. Surgical management of complicated rectovaginal fistulas and the role of omentoplasty. Tech Coloproctol 2017; 21:945-952. [DOI: 10.1007/s10151-017-1657-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/18/2017] [Indexed: 12/15/2022]
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Abstract
OBJECTIVES Rectovaginal fistulae (RVF) often represent surgical challenges, and treatment must be individualized. We describe outcomes after primary surgical repair stratified by fistula etiology and surgical approach. METHODS This retrospective cohort study included women who underwent surgical management of RVF at a tertiary care center between July 1, 2001 and December 31, 2013. Cases were stratified according to the following etiology: cancer (RVF-C), inflammatory bowel disease or infectious (RVF-I), and other (RVF-O). Patients with prior surgical treatment of RVF were excluded. Surgical approaches included local (seton, plug), transvaginal or endorectal, abdominal, diversion alone, or definitive (completion proctocolectomy with permanent colostomy or pelvic exenteration). Recurrence-free survival was estimated using the Kaplan-Meier method, and comparisons between subgroups were evaluated based on fitting Cox proportional hazards models. Censoring occurred at last relevant clinical follow-up. Factors contributing to recurrence-free survival were evaluated including age, body mass index, smoking status, fistula etiology, ileostomy, and surgical approach. RESULTS During the study period, 107 women underwent surgical repair of RVF. The most common fistula etiology was RVF-I (54.2%), followed by RVF-O (23.4%), and RVF-C (22.4%). Ninety-four women underwent fistula repair by the local (29.9%), transvaginal/endorectal (25.2%), abdominal approach (19.6%), or diversion alone (13.1%), whereas 13 underwent definitive surgery (12.2%). Recurrence-free survival was significantly different depending on surgical approach (P < 0.001), but not etiology (P = 0.71). Recurrence-free survival (95% confidence interval) at 1 year after surgery was 35.2% (21.8%-56.9%) for the local approach, 55.6% (37.0%-83.3%) for the transvaginal or endorectal approach, 95% (85.9%-100%) for the abdominal approach, and 33.3% (15%-74.2%) for those with diversion only. CONCLUSIONS Recurrence rates after RVF repair are high and did not differ by fistula etiology. Abdominal repair of RVF had significantly fewer recurrences.
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Santos Jasso KA, Medina Vega FA, Maza Vallejos J, Cabrera Hernández MA. Surgical repair of complex rectovaginal fistulas: Report of two cases. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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27
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Amil-Dias J, Kolacek S, Turner D, Pærregaard A, Rintala R, Afzal NA, Karolewska-Bochenek K, Bronsky J, Chong S, Fell J, Hojsak I, Hugot JP, Koletzko S, Kumar D, Lazowska-Przeorek I, Lillehei C, Lionetti P, Martin-de-Carpi J, Pakarinen M, Ruemmele FM, Shaoul R, Spray C, Staiano A, Sugarman I, Wilson DC, Winter H, Kolho KL. Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr 2017; 64:818-835. [PMID: 28267075 DOI: 10.1097/mpg.0000000000001562] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.
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Affiliation(s)
- Jorge Amil-Dias
- *Department of Pediatrics, Centro Hospitalar, S. João, Porto, Portugal †Children's Hospital Zagreb, Faculty of Medicine, Zagreb, Croatia ‡The Juliet Keidan Institute of Pediatric Gastroenterology & Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel §Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark ||Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland ¶Department of Pediatric Gastroenterology, University Hospital Southampton, Southampton, UK #Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland **Department of Pediatrics, University Hospital Motol, Prague, Czech Republic ††Queen Mary's Hospital for Children, Epsom and St Helier NHS Trust, Surrey ‡‡Chelsea and Westminster Hospital, London, UK §§Paris-Diderot Sorbonne-Paris-Cité University and Robert Debré Hospital, Paris, France ||||Pediatric Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, Ludwig Maximilians-University, Munich, Germany ¶¶St George's, University of London, London, UK ##Boston Children's Hospital and Harvard Medical School, Boston, MA ***Department NEUROFARBA, University of Florence - Meyer Hospital, Florence, Italy †††Unit for the Comprehensive Care of Pediatric Inflammatory Bowel Disease, Hospital Sant Joan de Déu, Barcelona, Spain ‡‡‡Department of Pediatric Gastroenterology, Necker Enfants Malades University Hospital, Sorbonne Paris Cité University, Paris Descartes University, Institut IMAGINE - INSERM U1163, Paris, France §§§Pediatric Gastroenterology Institute, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel ||||||Department of Pediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK ¶¶¶Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Naples, Italy ###Department of Pediatric Surgery, Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK ****Child Life and Health, University of Edinburgh, Scotland, UK ††††MassGeneral Hospital for Children, Harvard Medical School, Boston, MA ‡‡‡‡Children's Hospital, University of Helsinki, Helsinki, Finland
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Zheng H, Guo T, Wu Y, Li C, Cai S, Liu F, Xu Y. Rectovaginal fistula after low anterior resection in Chinese patients with colorectal cancer. Oncotarget 2017; 8:73123-73132. [PMID: 29069855 PMCID: PMC5641198 DOI: 10.18632/oncotarget.17046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
Abstract
Rectovaginal fistula is a postoperative complication of low anterior resection. We investigated the incidence of rectovaginal fistula (RVF) after low anterior resection, its risk factors and its optimal treatment. We analyzed data from 1,493 female patients who underwent low anterior resection for colorectal cancer between January 2006 and March 2016. We calculated the incidence of RVF and performed univariate and multivariate logistic regression analyses to identify risk factors. Twenty-four patients experienced RVF, giving an incidence of 1.61%. Univariate analysis revealed a short distance between the tumor and the anal verge (p < 0.001), longer surgery duration (p = 0.009), unsatisfactory anastomosis (p < 0.001), and greater intraoperative blood loss (p = 0.002) to be risk factors for RVF. Multivariate analysis showed that only distance between the tumor and the anal verge and unsatisfactory anastomosis were risk factors for RVF. Sixteen patients (66.7%) healed within a range of 30-1,225 days (median, 210 days). Twenty-one patients underwent surgery for diverting stoma; of those, 15 of them (71.4%) recovering after ostomy. These results indicate the primary risk factors for RVF are unsatisfactory anastomosis and short distance between the tumor and the anal verge. Most cases of RVF can be healed using a diverting stoma alone, without the need for additional surgery.
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Affiliation(s)
- Hongtu Zheng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tianan Guo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yuchen Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Cong Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Mwanri L, Gatwiri GJ. Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting. Reprod Health 2017; 14:38. [PMID: 28288664 PMCID: PMC5348742 DOI: 10.1186/s12978-017-0300-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 03/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is well acknowledged that Female Genital Mutilation/Cutting (FGM/C/C) leads to medical, psychological and sociocultural sequels. Over 200 million cases of FGM/C exist globally, and in Kenya alone, a total of 12,418,000 (28%) of women have undergone FGM/C, making the practice not only a significant national, but also a global health catastrophe. FGM/C is rooted in patriarchal and traditional cultures as a communal experience signifying a transition from girlhood to womanhood. The conversations surrounding FGM/C have been complicated by the involvement of women themselves in perpetuating the practice. METHODS A qualitative inquiry employing face-to-face, one-on-one, in-depth semi-structured interviews was used in a study that included 30 women living with obstetric fistulas in Kenya. Using the Social Network Framework and a feminist analysis we present stories of Kenyan women who had developed obstetric fistulas following prolonged and obstructed childbirth. RESULTS Of the 30 participants, three women reported that health care workers informed them that FGM/C was one of the contributing factors to their prolonged and obstructed childbirth. They reported serious obstetric complications including: the development of obstetric fistulas, lowered libido, poor quality of life and maternal and child health outcomes, including death. Fistula and subsequent loss of bodily functionalities such as uncontrollable leakage of body wastes, was reported by the women to result in rejection by spouses, families, friends and communities. Rejection further led to depression, loss of work, increased sense of apathy, lowered self-esteem and image, as well as loss of identity and communal sociocultural cohesion. CONCLUSION FGM/C is practised in traditional, patriarchal communities across Africa. Although the practice aims to bind community members and to celebrate a rite of passage; it may lead to harmful health and social consequences. Some women with fistula report their fistula was caused by FGM/C. Concerted efforts which embrace feminist understandings of society, as well as multi-sectoral, multidisciplinary and community development approaches need to be employed to address FGM/C, and to possibly reduce cases of obstetric fistulas in Kenya and beyond. Both government and non-government organisations need to be involved in making legislative, gender sensitive policies that protect women from FGM/C. In addition, the policy makers need to be in the front line to improve the lives of women who endured the consequences of FGM/C.
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Affiliation(s)
- Lillian Mwanri
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 2, Health Sciences Building, Registry Road, Bedford Park, South Australia, 5042, Australia.
| | - Glory Joy Gatwiri
- School of Arts & Social Sciences, Southern Cross University, Gold Coast Campus, Gold Coast, Australia
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Zhong Q, Yuan Z, Ma T, Wang H, Qin Q, Chu L, Wang J, Wang L. Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only. World J Surg Oncol 2017; 15:37. [PMID: 28153025 PMCID: PMC5288935 DOI: 10.1186/s12957-017-1100-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/12/2017] [Indexed: 12/17/2022] Open
Abstract
Background Radiation-induced rectovaginal fistula (RVF) is a severe and difficult complication after pelvic malignancy radiation. This study was to retrospectively compare the outcomes of restorative resection and colostomy only in remission of anorectal symptoms. Methods We enrolled a cohort of 26 consecutive cases who developed RVF after pelvic radiation. Two main procedures for these patients in our institution were used: one was restorative resection and pull-through coloanal anastomosis with a prophylactic colostomy, and another was a simple colostomy without resection. Thus, we divided these patients into these two groups. Anorectal symptoms including rectal pain, bleeding, tenesmus, and perineal mucous discharge were recorded and scored prior to surgery and at postoperative multiple time points. Results The baseline was similar among the two groups. All patients acquired good efficacy with improved symptoms at postoperative 6, 12, and 24 months, when compared to baseline. In addition, the resection group showed a better remission of tenesmus (6 months 33.3 vs 0%; 12 months 66.7 vs 16.7%) and perineal mucous discharge (6 months 88.9 vs 6.7%; 12 months 77.8 vs 15.4%; 24 months 85.7 vs 25.0%). Furthermore, three (30%) patients in the resection group successfully reversed stomas while no stoma was closed in the simple colostomy group. Conclusions Both restorative resection procedure and colostomy only can improve anorectal symptoms of radiation-induced RVF, but restorative resection can completely relieve anorectal symptoms in selected cases.
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Affiliation(s)
- Qinghua Zhong
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zixu Yuan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Tenghui Ma
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qiyuan Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lili Chu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jianping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor, Sun Yat-sen University, No.26, Road Yuancun ErHeng Road, Tianhe District, Guangzhou, 510655, China
| | - Lei Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China. .,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor, Sun Yat-sen University, No.26, Road Yuancun ErHeng Road, Tianhe District, Guangzhou, 510655, China.
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Abstract
BACKGROUND An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used. With high-volume fistulae, frequent product change can be painful and unpredictable in terms of efficacy. The psychologic distress is profound. Surgery may not be an option, making symptom control the priority. INSTRUMENT We report the use of a reusable menstrual silicone vaginal cup placed to divert and contain drainage. EXPERIENCE The menstrual cup provided significant symptom relief. Drainage is immediately diverted from tissue, unlike with tampon or pad use, which involves longer contact periods with caustic fluids. A system was created by adapting the end of the cup by adding silastic tubing and an external leg bag to provide long-term drainage control. CONCLUSION Improvement in quality of life is of primary importance when dealing with fistula drainage. This simple and inexpensive device should be considered in those cases in which the drainage can be diverted as a viable option, especially in those who are symptomatic and awaiting surgical repair or in those for whom surgery cannot be performed.
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She ZF, Yan XP, Ma F, Wang HH, Yang H, Shi AH, Wang L, Qi X, Xiao B, Zou YL, Lv Y. Treatment of rectovaginal fistula by magnetic compression. Int Urogynecol J 2016; 28:241-247. [PMID: 27530520 DOI: 10.1007/s00192-016-3097-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Rectovaginal fistula (RVF) is an abnormal epithelium-lined connection between the rectum and vagina. The primary effective treatment is surgical repair, but recurrence remains a challenge. Magnetic compression anastomosis (MCA), an alternative to suturing, has been developed to generate an anastomosis between various hollow viscera. We hypothesized that the MCA approach could be used to treat RVF. METHOD We designed a novel MCA device for RVF treatment and evaluated the magnetic compression procedure in a RVF pig model in comparison with the traditional suturing procedure. Following satisfactory outcomes, we also applied the MCA procedure to a human patient with recurrent RVF. The MCA device was designed based on the anatomical characteristics of the pig vagina and previous literature. The pig RVF model were established surgically (n = 12), and compression and control groups were each treated. The data were analyzed by one-way analysis of variance. RESULTS qqExcept in one animal in each group, the RVF site was smooth and healing was complete. Histological analysis confirmed complete healing of the RVF with high histological continuity to neighboring tissues. The compression procedure applied to our patient with RVF was successful. The patient recovered quickly without complications, and RVF did not recur during a 15-month follow-up. CONCLUSIONS From this preliminary investigation, MCA using our novel device appears to be a safe, simple, and effective nonsurgical procedure for the treatment of RVF.
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Affiliation(s)
- Zhan-Fei She
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China.,Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia, 017000, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China
| | - Feng Ma
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China
| | - Hao-Hua Wang
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China
| | - Huan Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China
| | - Ai-Hua Shi
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China
| | - Liang Wang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia, 017000, China
| | - Xin Qi
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia, 017000, China
| | - Bin Xiao
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia, 017000, China
| | - Yu-Liang Zou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China. .,XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China. .,Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi Province, 710061, China.
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Should Immunomodulation Therapy Alter the Surgical Management in Patients With Rectovaginal Fistula and Crohn's Disease? Dis Colon Rectum 2016; 59:670-6. [PMID: 27270520 DOI: 10.1097/dcr.0000000000000614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rectovaginal fistula in Crohn's disease is challenging for both healthcare providers and patients. The impact of immunomodulation therapy on healing after surgery is unclear. OBJECTIVE The purpose of this study was to examine whether immunomodulation therapy impacts healing after surgery for rectovaginal fistula in Crohn's disease. DESIGN This was a retrospective analysis with a follow-up telephone survey. SETTINGS The study was conducted at two major tertiary referral centers. PATIENTS All of the patients who underwent rectovaginal fistula repair from 1997 to 2013 at our centers were included. MAIN OUTCOME MEASURES A χ test and logistical regression analysis were used to study treatment outcomes according to type of procedure, recent use of immunosuppressives, and number of previous attempted repairs. Age, BMI, smoking, comorbidities, previous vaginal delivery/obstetric injury, use of probiotics, diverting stoma, and use of seton were also analyzed. RESULTS A total of 120 (62%) patients were contacted, and 99 (51%) of them agreed to participate in the study. Mean follow-up after surgical repair was 39 months. Procedures included advancement flap (n = 59), transvaginal repair (n = 14), muscle interposition (n = 14), episioproctotomy (n = 6), sphincteroplasty (n = 3), and other (n = 3); overall, 63% of patients experienced healing. Sixty-eight patients underwent recent immunomodulation therapy but did not exhibit statistical significance in outcome after surgical repair. In the subset of patients with fistula related to obstetric injury, a 74% (n = 26) healing rate after surgical repair was observed. Age, BMI, diabetes mellitus, use of steroids, probiotics, seton before repair, fecal diversion, and number of repairs did not affect healing. LIMITATIONS This was a retrospective analysis; the high volume tertiary referral inflammatory bowel disease centers studied may not be reflective of rectovaginal fistula presentation, treatment, or results in all patients, and the 3-year follow-up may not be sufficiently long. CONCLUSIONS Despite a relatively low success rate (63%) in healing after surgical repair of a rectovaginal fistula, the recent use of immunomodulation therapy did not negatively impact healing. However, tissue interposition techniques had the highest success rates.
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Karakayali FY, Tezcaner T, Ozcelik U, Moray G. The Outcomes of Ultralow Anterior Resection or an Abdominoperineal Pull-Through Resection and Coloanal Anastomosis for Radiation-Induced Recto-Vaginal Fistula Patients. J Gastrointest Surg 2016; 20:994-1001. [PMID: 26628070 DOI: 10.1007/s11605-015-3040-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/23/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes of patients who underwent colorectal resections and coloanal anastomosis for radiation-induced recto-vaginal fistulas (RVFs). The effect of the surgical treatment technique on bowel function, fecal continence, and quality of life of patients was also evaluated. METHODS Twenty-one female patients, who received adjuvant chemotherapy and external beam pelvic radiation for cervix carcinoma after radical hysterectomy + pelvic/paraaortic lymph node dissection, having RVF but without tumor recurrence, were included. All patients underwent an ultralow anterior resection (n = 11) or an abdominoperineal pull-through resection and straight coloanal anastomosis (n = 10). A bowel functions questionnaire and a Fecal Incontinence Quality of Life (FIQLI) questionnaire were applied to patients pre-operatively and also 6 months after the ileostomy closure procedures. RESULTS No recurrent RVF was observed in a mean follow-up period of 20 months after ostomy reversal procedures. The FIQLI depression, lifestyle, and embarrassment scores were significantly improved on the follow-up questionnaire. The mean pre- and post-operative incontinence scores were not significantly different. CONCLUSIONS The spontaneous closure rate after a simple diverting stoma is quite low and local repair procedures usually result in failure. In selected patients, performing a nearly total rectum resection and maintaining the intestinal continuity with a coloanal anastomosis may be accepted as a safe and curative option. Recurrence-free outcome and the improvement of the quality of life of the patients represent the efficiency of this treatment modality.
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Affiliation(s)
- Feza Yarbug Karakayali
- School of Medicine, Department of General Surgery, Baskent University Hospital, Istanbul, Turkey.
| | - Tugan Tezcaner
- School of Medicine, Department of General Surgery, Baskent University, Ankara, Turkey
| | - Umit Ozcelik
- School of Medicine, Department of General Surgery, Baskent University Hospital, Istanbul, Turkey
| | - Gokhan Moray
- School of Medicine, Department of General Surgery, Baskent University, Ankara, Turkey
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Yin HQ, Wang C, Peng X, Xu F, Ren YJ, Chao YQ, Lu JG, Wang S, Xiao HS. Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula. BMC Med Imaging 2016; 16:29. [PMID: 27053063 PMCID: PMC4823858 DOI: 10.1186/s12880-016-0131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/04/2016] [Indexed: 01/09/2023] Open
Abstract
Background Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). Methods Thirty inpatients and outpatients with suspected RVF from January 2006 to June 2013 were included in the study, among whom 28 underwent surgical repair. All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results. Results All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. Regarding the 30 internal openings located in the vagina during surgery, the positive predictive value of preoperative endosonography was 93 %. The six cases of simple fistulas confirmed during surgery were revealed by endosonography; for the 22 cases of complex fistula confirmed during surgery, the positive predictive value of endosonography was 90 %. Surgery confirmed 14 cases of anal fistula and 14 cases of RVF, whereas preoperative endoluminal ultrasonography suggested 16 cases of anal fistula and 12 cases of RVF, resulting in positive predictive values of 92.3 and 93 %, respectively. Conclusion The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. Thus, it is a good imaging tool for examining internal and external anal sphincter injuries and provides useful information for preoperative preparation and postoperative evaluation.
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Affiliation(s)
- Hao-Qiang Yin
- Department of Ultrasonic Diagnosis, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Peng
- Department of Ultrasonic Diagnosis, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Fang Xu
- Department of Ultrasonic Diagnosis, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Ya-Juan Ren
- Department of Ultrasonic Diagnosis, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Yong-Qing Chao
- Department of Anorectal Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jin-Gen Lu
- Department of Anorectal Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Song Wang
- Department of Radiology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Hu-Sheng Xiao
- Department of Ultrasonic Diagnosis, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Lambertz A, Lüken B, Ulmer T, Böhm G, Neumann U, Klink C, Krones C. Influence of diversion stoma on surgical outcome and recurrence rates in patients with rectovaginal fistula – A retrospective cohort study. Int J Surg 2016; 25:114-7. [DOI: 10.1016/j.ijsu.2015.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/23/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023]
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Kniery KR, Johnson EK, Steele SR. Operative considerations for rectovaginal fistulas. World J Gastrointest Surg 2015; 7:133-137. [PMID: 26328032 PMCID: PMC4550839 DOI: 10.4240/wjgs.v7.i8.133] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/26/2015] [Accepted: 07/02/2015] [Indexed: 02/06/2023] Open
Abstract
To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches 40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas.
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Lamazza A, Fiori E, Sterpetti AV, Schillaci A, De Cesare A, Lezoche E. Endoscopic placement of self-expandable metallic stents for rectovaginal fistula after colorectal resection: a comparison with proximal diverting ileostomy alone. Surg Endosc 2015; 30:797-801. [PMID: 26017913 DOI: 10.1007/s00464-015-4246-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/15/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Self-expandable metal stents can be used to treat patients with rectovaginal fistula after colorectal resection for cancer. METHODS Fifteen patients with rectovaginal fistula, after colorectal resection for cancer, were treated with endoscopic placement of a self-expandable metal stent. In four patients, a diverting proximal stoma had been performed elsewhere. Mean age was 58 years. All patients had preoperative radiotherapy. In ten patients, the stent was placed as initial form of treatment. Four patients were referred after multiple failed operations. The control group consisted of ten patients who had rectovaginal fistula and underwent proximal diverting ileostomy and percutaneous drainage of the surrounding abscess RESULTS One patient was not able to tolerate the stent, which was removed. At a mean follow-up of 22 months, the rectovaginal fistula healed in 12 patients. In the remaining two patients, the fistula has reduced significantly in size to allow a successful flap transposition. The fistula healed only in five out of the ten patients who had only a proximal ileostomy. CONCLUSIONS Endoscopic placement of self-expandable metal stents represents a valid adjunctive to treat patients with rectovaginal fistula, after colorectal resection for cancer.
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Affiliation(s)
- Antonietta Lamazza
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy
| | - Enrico Fiori
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy
| | - Antonio V Sterpetti
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy.
| | - Alberto Schillaci
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy
| | - Alessandro De Cesare
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy
| | - Emanuele Lezoche
- Policlinico Umberto I, University of Rome La Sapienza, Viale del Policlinico, 00167, Rome, Italy
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Oakley SH, Brown HW, Yurteri-Kaplan L, Greer JA, Richardson ML, Adelowo A, Lindo FM, Greene KA, Fok CS, Book NM, Saiz CM, Plowright LN, Harvie HS, Pauls RN. Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network. Female Pelvic Med Reconstr Surg 2015; 21:123-8. [PMID: 25730438 PMCID: PMC4994526 DOI: 10.1097/spv.0000000000000162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States. METHODS This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected. RESULTS Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (<0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists. CONCLUSIONS In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (<0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
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Affiliation(s)
- Susan H. Oakley
- Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH
| | - Heidi W. Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego Health System & Kaiser Permanente, San Diego, CA
| | - Ladin Yurteri-Kaplan
- Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
| | - Joy A. Greer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Monica L. Richardson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stanford University School of Medicine, Stanford, CA
| | - Amos Adelowo
- Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Fiona M. Lindo
- Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX
| | | | - Cynthia S. Fok
- Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL
| | - Nicole M. Book
- Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH
| | - Cristina M. Saiz
- Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA
| | - Leon N. Plowright
- Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Heidi S. Harvie
- Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel N. Pauls
- Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH
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Lamazza A, Fiori E, Schillaci A, Sterpetti AV, Lezoche E. Treatment of rectovaginal fistula after colorectal resection with endoscopic stenting: long-term results. Colorectal Dis 2015; 17:356-60. [PMID: 25524247 DOI: 10.1111/codi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/15/2014] [Indexed: 01/12/2023]
Abstract
AIM To treat patients with rectovaginal fistula after anterior resection for cancer using self-expanding metal stents. METHOD Ten patients of mean age of 56.3 years with rectovaginal fistula after colorectal resection for cancer were treated with endoscopic placement of a self-expanding metal stent. In three patients a diverting proximal stoma had been performed elsewhere. The rectal opening of the fistula was located from 3 to 10 cm from the anal verge (mean 6 cm). All patients had preoperative radiotherapy. In seven patients the stent was placed as the initial treatment while three referred patients had had multiple failed operations. RESULTS There were no complications after the procedure. At a mean follow-up of 24 months the rectovaginal fistula has healed without major faecal incontinence in eight patients. In the remaining two the fistula has reduced significantly in size to allow a successful flap transposition. CONCLUSION Endoscopic placement of a self-expanding metal stent is a valid adjunct to treat patients with rectovaginal fistula after colorectal resection for cancer.
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Affiliation(s)
- A Lamazza
- Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
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41
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Smith RK, Carter Paulson E. Perianal fistulas in patients with inflammatory bowel disease. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Endoscopic placement of self-expandable metal stents for treatment of rectovaginal fistulas after colorectal resection for cancer. Gastrointest Endosc 2014; 79:1025-7. [PMID: 24565070 DOI: 10.1016/j.gie.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 12/16/2022]
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43
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Nasser HA, Mendes VM, Zein F, Tanios BY, Berjaoui T. Complicated rectovaginal fistula secondary to Bartholin's cyst infection. J Obstet Gynaecol Res 2014; 40:1141-4. [PMID: 24428845 DOI: 10.1111/jog.12294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/08/2013] [Indexed: 11/26/2022]
Abstract
Rectovaginal fistula formation secondary to Bartholin's cyst is a very rare complication, and to date only three cases were reported in the literature. We report a case of a 32-year-old woman who suffered recurrent episodes of Bartholin's cyst infection with subsequent abscess formation that resulted in rectovaginal fistula formation. We treated her initially with transperineal repair; however, the fistulous tract recurred a month later. A laparoscopic colostomy and transperineal repair using biological graft was then performed, with excellent results. The patient underwent reversal of colostomy after 2 months, and remained asymptomatic upon follow-up 12 months later.
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Affiliation(s)
- Haydar A Nasser
- Free University of Brussels, Faculty of Medicine, Brussels, Belgium
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44
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Vigara García M, Cerdán Santacruz C, Gil Gregorio P, Cerdán Miguel J. [Sepsis, anaemia, anal incontinence, and presacral ulcer due to an unnoticed rectal-vaginal fistula in a nonagenarian]. Rev Esp Geriatr Gerontol 2013; 48:245-246. [PMID: 23522994 DOI: 10.1016/j.regg.2012.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/14/2012] [Accepted: 10/17/2012] [Indexed: 06/02/2023]
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45
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Abstract
Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.
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46
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Spontaneous healing of a rectovaginal fistula developing after laparoscopic segmental bowel resection for intestinal deep infiltrating endometriosis. Case Rep Obstet Gynecol 2013; 2013:837903. [PMID: 23710392 PMCID: PMC3655502 DOI: 10.1155/2013/837903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/09/2013] [Indexed: 02/07/2023] Open
Abstract
The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.
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47
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Sonoda LA, Rosenheck RE, Tierney K, Muderspach LI, Palmer SL, Senikowich M, Lin YG. Novel application of a fecal management system for vaginal use in radiotherapy-associated rectovaginal fistula. Palliat Med 2013; 27:91-3. [PMID: 22510312 DOI: 10.1177/0269216312443582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While highly effective for treating certain gynecologic malignancies, radiotherapy carries known risks, including fistula formation. We report a 75-year-old female with advanced cervical carcinoma who was provided a vaginally placed fecal management system after developing a rectovaginal fistula following primary treatment with chemoradiation. This report presents and discusses a novel method to palliate symptomatic RVFs in advanced-stage cancer.
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Affiliation(s)
- Laura A Sonoda
- Keck School of Medicine Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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48
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Borowiec AM, McCall M, Lees GM. The trans-sphincteric posterior sagittal repair of recto-urinary and recto-vaginal fistulae using Surgisis™ mesh and fibrin sealant. Tech Coloproctol 2012; 18:201-3. [PMID: 23095950 DOI: 10.1007/s10151-012-0917-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/01/2012] [Indexed: 01/17/2023]
Abstract
Recto-urinary, recto-vaginal and ileo-anal pouch-associated fistulae are rare yet a significant clinical problem due to their profound impact on patients' quality of life and are a challenge to repair. In this report, we describe repair of these complex fistulae using a modified trans-sphincteric posterior sagittal approach with Surgisis™ mesh and fibrin sealant and review our repair outcomes.
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Affiliation(s)
- A M Borowiec
- Department of Surgery, 2C3.62 WMC, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada,
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49
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Puntambekar S, Rayate N, Agarwal G, Joshi S, Rajmanickam S. Robotic rectovaginal fistula repair. J Robot Surg 2012; 6:251-3. [PMID: 27638282 DOI: 10.1007/s11701-011-0282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
Abstract
Minimally invasive surgery for diseases in the pelvic region is gaining popularity due to advances in technology and increased benefit to the patient. As indications for such surgeries increase, the known boundaries for minimal access are being extended by a few teams. We report a patient who underwent robotic-assisted transabdominal repair of a high rectovaginal fistula which developed following a vaginal hysterectomy. Vaginography revealed a communication between the vaginal vault and the upper rectum. After evaluation of the colon and the vagina, the patient was planned for a robotic-assisted rectovaginal fistula repair. The three-arm daVinci(®) surgical robot was used. A total of five ports were used to complete the entire procedure, which included adhesiolysis, re-creation of the vaginal vault, repair of the fistula and omental interposition. This is the first robotic-assisted rectovaginal fistula repair reported to date. Besides the advantages of minimally invasive surgery for the patient, the surgeon benefits from the ease of suturing deep in the pelvis afforded by the articulated robotic arms.
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Affiliation(s)
- Shailesh Puntambekar
- Department of Minimal Access Cancer Surgery, Galaxy CARE Laparoscopy Institute, 25-A, Karve Road, Erandwane, Pune, 411004, India.
| | - Neeraj Rayate
- Department of Minimal Access Cancer Surgery, Galaxy CARE Laparoscopy Institute, 25-A, Karve Road, Erandwane, Pune, 411004, India
| | - Geetanjali Agarwal
- Department of Minimal Access Cancer Surgery, Galaxy CARE Laparoscopy Institute, 25-A, Karve Road, Erandwane, Pune, 411004, India
| | - Sourabh Joshi
- Department of Minimal Access Cancer Surgery, Galaxy CARE Laparoscopy Institute, 25-A, Karve Road, Erandwane, Pune, 411004, India
| | - Sarvana Rajmanickam
- Department of Minimal Access Cancer Surgery, Galaxy CARE Laparoscopy Institute, 25-A, Karve Road, Erandwane, Pune, 411004, India
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50
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Schloericke E, Hoffmann M, Zimmermann M, Kraus M, Bouchard R, Roblick UJ, Hildebrand P, Nolde J, Bruch HP, Limmer S. Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas. Colorectal Dis 2012; 14:604-10. [PMID: 21752173 DOI: 10.1111/j.1463-1318.2011.02719.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Deep rectovaginal fistulas are a rare entity and pose a delicate challenge for the surgeon. The present study introduces different operative interventions involved in transperineal omental flap surgery. METHOD A retrospective analysis of all patients treated with a low or mid rectovaginal or enterovaginal fistula at the Department of Surgery of the University Hospital of Schleswig-Holstein, Campus Luebeck, was performed. Treatment results were discussed with respect to aetiology, localization, morbidity and outcome. RESULTS Between the years 2000 and 2010, a total of nine patients with a low or mid rectovaginal fistula were treated at our clinic. After local fistulectomy, all patients were additionally treated by a laparoscopically assisted omental flap reconstruction of the rectovaginal and perineal space. Eight of the nine patients received a protective ileostomy or colostomy. Only the patient with a history of Crohn's disease had no ileostomy raised. At a median follow-up of 22 months, no patient experienced recurrence of a rectovaginal fistula. Perioperative mortality was zero and minor complications were observed in 22%. Major complications were an anastomotic insufficiency after low anterior resection that was treated without further interventions. Another complication was a persistent fistula within the sphincter that needed re-operation and bovine plug repair combined with a mucosa flap. CONCLUSIONS Complete omental reconstruction of the rectovaginal space appears decisive in the operative therapy of deep rectovaginal or enterovaginal fistulas. Comparative studies on standard therapies are necessary although direct comparison of case series is difficult.
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Affiliation(s)
- E Schloericke
- Department of Surgery, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
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