Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

Department of Gastrointestinal Surgery, Gem Hospital, Coimbatore, India.
BMC Surgery (Impact Factor: 1.24). 02/2005; 5:20. DOI: 10.1186/1471-2482-5-20
Source: PubMed

ABSTRACT Rectovaginal fistula (RVF) is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature.
We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature.
The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found.
Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.

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    ABSTRACT: Una fistola rettovaginale può essere definita come una comunicazione tra parete anteriore del retto e faccia posteriore della vagina, al di sopra dell’apparato sfinteriale anale. Il trattamento non può pertanto essere fatto mediante fistolotomia, pena la comparsa di incontinenza anale. Le fistole rettovaginali alte traumatiche comprendono le fistole postchirurgiche, le fistole postostetriche e i traumi non chirurgici. Il loro trattamento è spesso difficile e soggetto a recidiva. Per minimizzare questo rischio è utile confezionare una stomia derivativa per le feci che permette una miglior guarigione postchirurgica locale riducendo la pressione endorettale e riducendo la sepsi endoluminale. Sono state descritte numerosissime tecniche per il trattamento di una fistola rettovaginale alta traumatica e le indicazioni sono funzione della esatta sede del tramite, della causa della fistola, dell’ambiente locale e delle caratteristiche della fistola, con la primo posto il suo calibro. Gli interventi per via bassa comportano la sutura diretta, un lembo di abbassamento rettale o vaginale, la sovrapposizione e le trasposizioni muscolari come il lembo di Martius o la graciloplastica. Gli interventi per via alta o mista comprendono le suture dirette con eventuale interposizione di omento, le rettoplastiche (sempre meno eseguite) e le resezioni rettali.
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    Indian Journal of Surgery 01/2015; DOI:10.1007/s12262-015-1218-7 · 0.27 Impact Factor
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    ABSTRACT: Background Rectovaginal fistulas occur as a complication of surgery or radiation therapy, an obstetrical trauma, malignant process and inflammatory bowel disease. These fistulas comprise 5% of all anorectal fistulas. The presenting symptoms vary according to the characteristics of the fistula and the underlying cause. Methods This review article evaluates in detail each of those aspects from a clinician’s perspective. Results Symptoms referring to the aetiology and process of evaluating the location, length and diameter of the fistula are described here in detail as critical to selecting the appropriate surgical technique. However, successful fistula healing is much less than certain after every repair attempt, even in the most experienced hands. Nevertheless, re-operation is deployed in such cases. A diverting colostomy might also be needed as a last resort to relieve the symptoms. Morbidity of a rectovaginal fistula is increased, and from a psychosocial perspective, it can dramatically alter the sexual and reproductive life of a female with consequences to her self-esteem. Conclusions The surgical repair of rectovaginal fistulas is a challenge even for the most experienced and dedicated of anal surgeons. Healing rectovaginal fistulas with underlying aetiology might be an unattainable goal even with recurrent attempts, sometimes necessitating amputation surgery.
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 03/2014; 86(2):72-82. DOI:10.1007/s13126-014-0101-5

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