Cases Of Rectovaginal Fistula Research Articles

Rectovaginal Fistula Repair Following Vaginoplasty in Transgender Females: A Systematic Review of Surgical Techniques

Background: Rectovaginal fistula (RVF) remains a complex complication following gender-affirming vaginoplasty. This review aims to evaluate RVF repair techniques and outcomes following vaginoplasty. Methods: A systematic review was performed per PRISMA guidelines. Ovid MEDLINE, Ovid EMBASE, Cochrane, and Web of Science were queried for records pertaining to RVF repair following vaginoplasty. Study characteristics, operative details, and demographics were collected. Outcomes included RVF repair method, recurrence rate, and complications. Results: Among 282 screened citations, 17 articles representing 41 patients were included. Rectovaginal fistula repair methods identified included 4 conservative management approaches (n = 12 patients), primary closure with or without fistulectomy and ostomy (n = 22), 10 reconstructive surgical techniques (n = 18). The most common reconstructive techniques were V-Y full-thickness advancement with rectal flap (n = 5) and infragluteal fasciocutaneous flap (n = 4). Median time to recurrence was 6 months (interquartile range 7.5). Reported RVF repair complications included RVF recurrence (n = 5, 14.7%) and wound complication or dehiscence (n = 2, 5.88%). Three cases of RVF recurred after primary closure with or without fistulectomy and ostomy, while 2 cases of recurrence followed reconstruction. Conclusion: There remains a high level of variability in the approach to RVF repair following vaginoplasty. Reconstructive surgical techniques may be a more optimal solution without necessitating ostomies, but this decision must be considered in the context of RVF location, individual patient expectations, and clinical presentation.

Rectovaginal Fistula in Women With Pessary for Pelvic Organ Prolapse: A Case Series and Literature Review.

In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries. Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary. Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries. Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.

Surgical outcome for colorectal or urinary tract-related fistula: Usefulness of vascularized tissue transfer—a retrospective study⁎

It is challenging to manage colorectal or urinary tract-related fistula. We typically treat colorectal or urinary tract-related fistula with a vascularized tissue transfer. This study aimed to analyze the outcomes of our surgical treatments for colorectal or urinary tract-related fistula. This retrospective review included all patients who underwent surgical repair of a colorectal or urinary tract-related fistula at our institution from October 2004 to September 2019. Patients whose surgical outcomes could not be evaluated were excluded. The primary outcome was the overall cure rate. We also evaluated the complication rate and compared the outcomes for rectovaginal fistula with those for urorectal fistula. The final analysis included 38 cases, of which 17 were rectovaginal fistula and 16 were urorectal fistula. The transperineal approach was used in 28 cases and transperineal and transabdominal combined in nine cases. A gracilis muscle flap was used in 19 cases and a gluteal fold flap in 13 cases. Although a major leak occurred in nine cases, the fistula was finally cured successfully in 31 cases. A comparison of the outcomes for rectovaginal fistula and urorectal fistula showed that complications occurred in 5/17 cases of rectovaginal fistula and 10/16 cases of urorectal fistula (p = 0.056). Fistulae were cured successfully in 13/17 cases of rectovaginal fistula and 14/16 cases of urorectal fistula (p = 0.656). Our surgical treatment for colorectal or urinary tract-related fistula succeeded in 31 of 38 cases. Thus, vascularized tissue transfer is useful for refractory colorectal or urinary tract-related fistula.

Rectovaginal fistula after low anterior resection in Chinese patients with colorectal cancer.

Rectovaginal fistula is a postoperative complication of low anterior resection. We investigated the incidence of rectovaginal fistula (RVF) after low anterior resection, its risk factors and its optimal treatment. We analyzed data from 1,493 female patients who underwent low anterior resection for colorectal cancer between January 2006 and March 2016. We calculated the incidence of RVF and performed univariate and multivariate logistic regression analyses to identify risk factors. Twenty-four patients experienced RVF, giving an incidence of 1.61%. Univariate analysis revealed a short distance between the tumor and the anal verge (p < 0.001), longer surgery duration (p = 0.009), unsatisfactory anastomosis (p < 0.001), and greater intraoperative blood loss (p = 0.002) to be risk factors for RVF. Multivariate analysis showed that only distance between the tumor and the anal verge and unsatisfactory anastomosis were risk factors for RVF. Sixteen patients (66.7%) healed within a range of 30-1,225 days (median, 210 days). Twenty-one patients underwent surgery for diverting stoma; of those, 15 of them (71.4%) recovering after ostomy. These results indicate the primary risk factors for RVF are unsatisfactory anastomosis and short distance between the tumor and the anal verge. Most cases of RVF can be healed using a diverting stoma alone, without the need for additional surgery.

Anorectal Agenesis with Rectovaginal Fistula: A Rare/Regional Variant.

Aims and Objectives:The anatomical types of female anorectal malformation (ARM) are complex and include several rare and regional variants. The aim of this report is to highlight the diagnosis and management of cases of anorectal agenesis with rectovaginal fistula (RVF).Materials and Methods:This is a retrospective chart review of cases of RVF who underwent definitive surgery between November 2000 and September 2016 in a single institution.Results:Of the 244 female patients with anorectal anomalies treated in our institution over a 16-year period, there were 15 cases of RVF with anorectal agenesis giving it an incidence of 6%. All cases of RVF with anorectal agenesis presented with absence of anal opening, varying degree of abdominal distension, and history of passage of fecal matter per vaginum. The mean age of presentation was 3 months (newborn to 1 year). Sigmoid colostomy was done in 13 cases. Distal colostogram demonstrated high RVF which was further confirmed by examination under anesthesia (EUA) and endoscopy before definitive surgery. With the posterior sagittal approach, division of the RVF and anorectoplasty was possible in 14 cases; however, one patient required an abdominal mobilization of the colon for pull through due to a very short distal bowel segment. During a mean postoperative follow-up of 5 years, cosmetic and functional results were satisfactory.Conclusion:RVF with anorectal agenesis is a rare/regional variant of female ARMs. Clinical examination along with distal colostogram, EUA, and endoscopy clinches the diagnosis. Anorectal reconstruction by posterior sagittal anorectoplasty results in a satisfactory outcome.

Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula.

BackgroundRectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF).MethodsThirty inpatients and outpatients with suspected RVF from January 2006 to June 2013 were included in the study, among whom 28 underwent surgical repair. All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results.ResultsAll of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. Regarding the 30 internal openings located in the vagina during surgery, the positive predictive value of preoperative endosonography was 93 %. The six cases of simple fistulas confirmed during surgery were revealed by endosonography; for the 22 cases of complex fistula confirmed during surgery, the positive predictive value of endosonography was 90 %. Surgery confirmed 14 cases of anal fistula and 14 cases of RVF, whereas preoperative endoluminal ultrasonography suggested 16 cases of anal fistula and 12 cases of RVF, resulting in positive predictive values of 92.3 and 93 %, respectively.ConclusionThe use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. Thus, it is a good imaging tool for examining internal and external anal sphincter injuries and provides useful information for preoperative preparation and postoperative evaluation.

Rectovaginal Fistula of Different Etiologies: Clinical Case Reports

We report three cases of recto vaginal fistula (RVF) due to different etiologies. First case was due to sexual trauma (vaginal intercourse) which is not very common. The second case was due to obstetric trauma (the most common etiology of RVF) and the third case was caused by chronic lower genito-urinary infection in a HIV positive lady. We have included the successful surgical procedures of first two cases. But the repairing of the third case was failed hence planned to operate after six months. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11143 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 43-46

Double-stapled transanal rectotomy (STARR procedure) for obstructed defecation syndrome seems to have a low degree of acceptance amongst older surgeons

Dear Editor: We have been studying the evolution of double-stapled transanal rectotomy (STARR) with great care and interest and came to the conclusion that, despite an increasing number of studies and publications showing the efficacy of the procedure [1], there still seems to be a low degree of acceptance amongst older surgeons. Mario Pescatio et al. published a paper on two cases of rectovaginal fistula following the STARR procedure [2]. Rectovaginal fistulas definitely belong to the possible complications associated with the procedure [2]. However, there is no surgical procedure void of complications. The incidence and severity of surgical complications depend on many factors, the most important of which is the surgeon! Most important, however, are the clinical and subjective results following the STARR procedure. A great degree of clinical and subjective relief has been described in many publications [3]. The STARR procedure is accompanied by less postoperative pain, a shorter hospital stay and a faster return to work, just to name a few. These are factors that greatly influence the patients' socio-economic life. Nowadays, patients present with printouts from extensive internet research demanding new and less invasive surgical procedures. The surgical decision no longer lies in the hands of the surgery alone! The patient's choice is legally binding and greatly influences the choice of surgical procedures. We do agree that obstructed defecation has a multifactor aetiology, and there is need of an extensive diagnostic work up (dynamic perineal ultrasound studies, defecography, MRI, etc.), as well as non-surgical therapeutic measures (biofeedback, laxatives, etc.) prior to surgery. At the moment however, we consider the procedure based on numerous publications and our institutional experience as safe and adequate in the treatment of patients with surgically treatable causes of obstructed defecations syndrome [4]. Serious complications including rectovaginal fistula remain rare with adequate surgical training. The question is “is this low degree of acceptance of the STARR procedure amongst older surgeons related to unwillingness to learn new surgical techniques?”

Bibliographical Notices Vesico-vaginal Fistula from Parturition and other Causes; with Cases of Recto-vaginal Fistula . By Thomas Addis Emmet, M.D., Surgeon-in-chief to the New York State Woman's Hospital. New York: Wm. Wood &amp; Co. 1868. 8vo. pp. 250.

Bibliographical Notices Vesico-vaginal Fistula from Parturition and other Causes; with Cases of Recto-vaginal Fistula . By Thomas Addis Emmet, M.D., Surgeon-in-chief to the New York State Woman's Hospital. New York: Wm. Wood &amp; Co. 1868. 8vo. pp. 250.