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Laparoscopic stapler repair of high rectovaginal fistula: A case report

Open Journal of Gastroenterology 2013年第1期3卷 35-37页

作者： Amit Kumar Parmar Mittu John Mathew Prasanna Kumar Reddy Department of Surgical Gastroenterology and Minimal Access Surgery Apollo Hospital Chennai India

For thousands of years, women simply tolerated the distressing symptoms generated by rectovaginal fistulas (RVFs). This is no longer necessary because most RVFs can be surgically corrected via a number of approaches. Most rectovaginal fistulas are acquired;obstetric injury alone accounts for nearly 88% of the cases. The high fistulas are repaired by abdominal approach, while middle or low fistulas are best approached perineally. There are only few case reports of laparoscopic RVF repair noted in literature till date. Laparoscopic repair of RVF is challenging and requires advanced laparoscopic skill. Laparoscopy is a better alternative in selected cases of RVF and yields faster recovery and good patient compliance. We present a case of high RVF managed laparoscopically by using stapler.

关键词： Laparoscopy rectovaginal Fistula Stapler

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Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas

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World Journal of Gastroenterology 2013年第39期19卷 6625-6629页

作者： Xiao-Bing Chen You-Xin Wang Hua Jiang Dai-Xiang Liao Jun-Hui Yu Cheng-Hua Luo Department of General and Colorectal Surgery Beijing Shijitan HospitalCapital Medical University Beijing Municipal Key Laboratory of Clinical Epidemiology School of Public HealthCapital Medical University Department of Gastroenterology and Hepatology Chinese PLA General Hospital

AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively *** muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early *** was assessed in terms of the success rate and surgical ***-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after ***:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment *** a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 *** improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or *** was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing ***:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and *** and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.

关键词： rectovaginal fistula Rectourethral fistula Gracilis muscle Quality of life Therapeutic irrigation

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Operative considerations for rectovaginal fistulas

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World Journal of Gastrointestinal Surgery 2015年第8期7卷 133-137页

作者： Kevin R Kniery Eric K Johnson Scott R Steele Department of Surgery Division of Colorectal SurgeryMadigan Army Medical Center

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 approaches40% 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.

关键词： rectovaginal fistulas Anovaginal fistulas

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Contemporary surgical management of rectovaginal fistula in Crohn's disease

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World Journal of Gastrointestinal Pathophysiology 2014年第4期5卷 487-495页

作者： Michael A Valente Tracy L Hull Department of Colorectal Surgery Digestive Disease Institute Cleveland Clinic Cleveland OH 44195 United States

rectovaginal fistula is a disastrous complication of Crohn's disease(CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.

关键词： rectovaginal fistula Crohn’s disease Fistula Advancement flap Sleeve advancement Episioproctotomy

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