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

Department of Gastrointestinal Surgery, Gem Hospital, Coimbatore, India.
BMC Surgery (Impact Factor: 1.4). 02/2005; 5(1):20. DOI: 10.1186/1471-2482-5-20
Source: PubMed


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.

Download full-text


Available from: Alfie J Kavalakat
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rectovaginal fistulas account for less than 5% of all anorectal fistulas. They may occur as a result of obstetrical injuries, inflammatory bowel diseases, or pelvic cancer irradiation. The aim of the study was to describe the results of different methods of surgical treatment according to the etiology and localization of rectovaginal fistulas. Material and methods. The study included 23 female patients who underwent operations for rectovaginal fistulas within the period of 1995 to 2006. The age of patients ranged from 18 to 64 years, with an average age of 41 years. 14 patients received radical treatment according to the etiology and localization of the fistulas: four were treated with abdominal approach, six with a local excision of the rectovaginal fistula involving layer closure of rectal and vaginal openings and interposition of musculomucosal flaps, and four with a simple fistulectomy involving the removal of inflamed tissue and the reconstruction of the perineal body, anal sphincters, and all layers of the rectal and vaginal walls. In nine cases, patients received a palliative surgical treatment to address extensive tissue destruction resulting from radiotherapy for uterine cervix cancer or advanced rectal cancer. Results. Complete recovery occurred in patients who underwent laparotomy for rectovaginal fistulas following inflammatory bowel disease or complicating anterior resection of the rectum. Patients operated on using rectal and vaginal approaches displayed positive results, as did those who underwent, fistulectomy with perineal body and anal sphincter reconstruction. Conclusions. Various surgical techniques are available for the management of rectovaginal fistulas depending on their etiology, size, and location. The best results of low rectovaginal fistula treatment occurred using fistuleetomy with layer closure and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.
    No preview · Article · Jan 2007
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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. Etiologies include obstetrical trauma, inflammatory bowel disease, malignant processes, and complications of radiation therapy and surgery. Repair options include local repairs, tissue transfer techniques, and abdominal operations.
    Full-text · Article · May 2007
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Dec 2008
Show more