Ziouziou I, Ammouri S, Ouazni M, Sumba H, Koutani A, Iben Attya Andaloussi A. Recto-vaginal fistulas: A case series.
Int J Surg Case Rep 2020;
72:147-152. [PMID:
32535530 PMCID:
PMC7298318 DOI:
10.1016/j.ijscr.2020.05.059]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 01/13/2023] Open
Abstract
Falandry and Martius’ techniques were used firstly for vesico-vaginal fistulas with satisfying long-term functional results.
The same techniques are feasible and safe for rectovaginal fistula repair.
In this case series, patients had an improvement of their self-image and health-related quality of life.
Temporary colostomy is recommended before this reconstructive surgery.
Introduction
Rectovaginal fistula (RVF) is defined as an abnormal communication between the anterior wall of the rectum and the posterior wall of the vagina. Many surgical techniques have been described in the treatment of RVF. However, none has proved its superiority. The aim of the study was to evaluate the functional results of surgical treatment of RVF using Martius and Falandry techniques in order to assess the feasibility and the efficacy of these techniques which were first described for vesico-vaginal fistulas.
Methods
The study was a retrospective case series conducted in a single centre: Department of general surgery at Ibn Sina University Hospital in Rabat. We included patients with rectovaginal fistula consecutively recruited from 2011 to 2014. 10 patients developed RVF after surgery for rectal cancer (9 cases), uterine cancer (1 case). One patient had RVF for ano-rectal malformation. Colostomy was performed before the treatment of fistula in 9 cases (82 %). They underwent surgical treatment using Falandry (8 patients) and Martius techniques (3 patients) performed by an experienced urologist surgeon.
Results
No postoperative complications were recorded. Time to discharge was postoperative day 3–4. There was a complete disappearance of RVF in 8 patients (72.7 % of cases), relapse in 2 cases (18 %), and failure in one case (9%). The average follow-up was 12.6 +/-10 months. Functionally, no long-term cases of fecal incontinence or dyspareunia were noted.
Conclusion
The choice of surgical technique in the treatment of RVF remains difficult because of poor literature data and absence of consensus. RVF repair results either by Martius or Falandry techniques are encouraging with low morbidity.
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