Document Detail


Treatment of rectovaginal fistulas that has failed previous repair attempts.
MedLine Citation:
PMID:  7656738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The purpose of this study was to assess results of treatment of rectovaginal fistulas (excluding pouch vaginal fistulas) that have failed previous attempts at repair. METHOD: A retrospective chart review of all patients presenting with nonhealing rectovaginal fistula was performed. RESULTS: Twenty eight patients with persistent fistulas were identified. In 18 patients the fistula was classified as simple, and in 10 the fistula was complex. Fourteen fistulas were secondary to obstetric injury, five were caused by Crohn's disease, and nine patients had miscellaneous etiologies for their fistulas. Of patients with persistent simple fistulas, 13 (72 percent) of the fistulas healed, 5 after advancement flaps, 5 following sphincteroplasty, and 3 after coloanal anastomoses. Of persistent complex fistulas, only four of ten (40 percent) healed, one following sphincteroplasty, one with coloanal anastomosis, and two after gracilis transposition. A total of 23 advancement flaps were done in 17 patients with five fistulas healing (29 percent). Sphincteroplasty and fistulectomy was successful in six of seven patients (86 percent). Coloanal anastomosis resulted in healing of four of six patients (67 percent) in whom it was attempted. Gracilis muscle transfer was successful in two of two patients (100 percent). CONCLUSION: Persistent rectovaginal fistula presents a difficult management problem. Choice of operation must be tailored to the underlying pathology and type of repair previously done. Advancement flap repair is generally not recommended for persistent complex fistulas or for simple fistulas that have failed a previous advancement flap repair.
Authors:
H M MacRae; R S McLeod; Z Cohen; H Stern; R Reznick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  38     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  1995 Sep 
Date Detail:
Created Date:  1995-10-03     Completed Date:  1995-10-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  921-5     Citation Subset:  IM    
Affiliation:
Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anal Canal / surgery
Anastomosis, Surgical
Colon / surgery
Female
Humans
Middle Aged
Rectovaginal Fistula / etiology,  surgery*
Rectum / surgery
Reoperation
Retrospective Studies
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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