Abstract
Introduction: Rectovaginal fistulas represent an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. We retrospectively evaluated our experience with the gracilis interposition procedure to assess its efficacy in repairing rectovaginal fistulas. Materials and Methods: We performed a retrospective study of all patients who underwent gracillis muscle interposition flap in our institution from January 2015 to November 2018 for the repair of fistulas between the rectum and vagina arising from diverse etiologies. Results: Rectovaginal fistula repair with gracilis muscle interposition was done in twelve patients. The etiologies were obstetric trauma (n=7), trauma (n=3), post arteriovenous malformation excision (n=1) and one patient had fistula after excision of squamous papilloma of rectum. Overall all the patients with gracilis interposition flap resulted in complete healing, a success rate of 100 percent. Discussion: Various surgical procedures have been suggested for the repair of these fistulas, including fecal diversion, primary repair, endorectal advancement flap, transvaginal repair, coloanal sleeve anastomosis, and interposition flaps. The reported success rate for the repair of rectovaginal or rectourethral fistulas using the gracilis muscle interposition technique is generally much higher than that reported for other repair techniques. Conclusion: Given the high success rate and low complication rate, repair with gracilis muscle interposition is recommended for fistulas with unfavorable local conditions, such as those present after radiation or subsequent to long-term, persistent infection, and especially after failed previous repairs. Keywords: Rectovaginal fistula, Gracilis muscle, Interposition.
Published Version
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