Clinical and functional features of rectal sphincter in patients with rectovaginal fistulas before and after split vaginal-rectal flap application

Abstract

Dysfunction of the rectal sphincter is noted in more than 70 % of patients with rectovaginal fistulas (RVF), which require an extremely careful evaluation of the rectal sphincter function both by clinical and instrumental methods. Objective: to study the state of rectal sphincter in patients with rectovaginal fistulas before and after surgical treatment. Materials and methods: in the period from 2012 to 2021 198 patients (age from 20 to 73 years, Me = 35 (30; 45)) were included in the comprehensive study of the rectal sphincter functional state before and after surgical treatment. 106 (53,5 %) cases were recurrent. Traumatic childbirth was the most common cause of RVF (43,9 %). Results: dysfunction of the rectal sphincter is revealed in 154 (77,8 %) patients with rectovaginal fistulas. The etiology of the disease and the recurrent course do not affect the severity of the rectal sphincter functional disorders. Using of a split rectal-vaginal flap do not lead to a worsening of the rectal sphincter function. Conclusion: A significant mismatch between the obtained objective (sphincterometry) and subjective (Wexner scale) data of the rectal sphincter function in patients with rectovaginal fistulas proves the need for sphincterometry in this category of patients. Elimination of rectovaginal fistulas by using a split vaginal-rectal flap is a safe and low-traumatic surgical method.