2048 Colo -Anal Anastomosis: A Novel Idea for Treatment of Re-Re-Recurrent Rectovaginal Fistula

Abstract

Video Objective Treatment of rectovaginal fistulas was always difficult; treating post radiation recurrent rectovaginal fistulas was challenging; Colo-Anal Anastomosis is a novel way of treating such fistulas. Setting 49yr/Female/P1L1 had undergone Total Abdominal Hysterectomy for AUB-E; was diagnosed with adenocarcinoma of endometrium stage II. Patient underwent BPLND + BSO 3 weeks later and then took 25# radiation for same. Patient developed radiation proctitis and Rectovaginal Fistula following Radiation Therapy. A diversion colostomy was done for same. Patients complaints persisted. Patient then underwent RVF closure with omental flap interposition. Despite the omental flap a distal loopogram was suggestive of leak of dye. Interventions Decision was taken to do a Laparoscopy with Colo Anal Anastomosis. Expected challenges were dense bowel adhesions; deficient anterior rectal wall; Non healing tissue. On Laparoscopy small bowel adhesiolysis was done. Colon was completely mobilized upto splenic flexure so as to obtain a tension free repair. Rectum transected proximal to fistula site. A tunnel was created in the distal rectum. Rectal Mucosa was excised so as to avoid mucus passage. Mobilized bowel was then pulled out through the tunnel. Colon was anastomsed to anal canal perineally by simple interrupted sutures. As anal sphincters were not dissected patient's anal tone was well maintained. Rectal drain was placed. Patient was gradually started on full diet by day 3; rectal drain was removed on day3 post op. Dye study done postoperatively showed no leak of dye. Conclusion Colo Anal Anastomosis is a unique way of treating fistulas not responding to routine RVF repair procedures.