Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?
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.
Full-textDOI: · Available from: Alfie J Kavalakat, May 30, 2015
SourceAvailable from: Vibha VarmaIndian Journal of Surgery 01/2015; DOI:10.1007/s12262-015-1218-7 · 0.27 Impact Factor
[Show abstract] [Hide abstract]
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
[Show abstract] [Hide abstract]
ABSTRACT: We propose a new minimally invasive technique by laparoscopic approach which minimizes parietal damage and allows precise location of the fistula, hence reduces blind dissection. Ten consecutive patients suffering from a HRVF benefited from the described technique. Location and time frame were east of the Democratic Republic of Congo and September 2012 through January 2014. By laparoscopy, dissection of the mesorectum in the "holy plane" is taken posteriorly as distally on the sacrum as possible. Dissection subsequently continues laterally beyond the fistula in an effort to maximally circumvene the fistulous area where no plane of cleavage can be found. If the cleavage plane beyond the fistula addresses a healthy rectum, a suture of vaginal and rectal defect is performed. If the cleavage plane beyond the fistula involves significant laceration of the rectum, while leaving at least 2 cm of healthy rectum above the sphincter, rectal resection and colorectal anastomosis are performed. If the rectal laceration involves the distal 2 cm but halts short of the sphincter (large fistula), the pull-through technique is performed. Of ten participants, four had large HRVF and two presented significant fibrosis. Three underwent simple suture of rectal and vaginal defect, one rectal resection and six a "pull-through" technique. The median procedure time was 1h50 (1h00-3h30). There was no morbidity. None of the patients required protective ileostomy or colostomy. Nine patients were declared clinically cured with a median follow-up of 14.3 months (11-36). The Cleveland Clinic Incontinence Score was 20 in all patients before the treatment and was significantly (p = 0.004) reduced to 2.6 [0-20] after the treatment. This minimally invasive technique allowed us to treat HRVF, including complex ones in ten patients without significant morbidity. Clinical success with a median follow-up of 14.3 months was 90 %.Surgical Endoscopy 04/2015; DOI:10.1007/s00464-015-4192-z · 3.31 Impact Factor