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Published on: February 12, 2022
[Postobstetric rectovaginal fistula: surgical treatment using endorectal advancement flap]
Ulises Rodríguez-Wong1, Juan Manuel Cruz-Reyes, José Refugio Santamaría-Aguirre
1Servicio de Cirugía General, Hospital Juárez de México, México, D.F., Mexico. ulisesromed@prodigy.net.mx
Background:
Rectovaginal fistulas account for <5% of all rectal fistulas. Obstetrical injuries are the most common cause of these types of fistulas. There have been a multitude of surgical approaches developed for operative repair.
Methods:
Between January 1992 and December 2006, 16 patients with postobstetric rectovaginal fistula were treated at the Hospital Juárez of México. Age, type of obstetric trauma, time elapsed between delivery and beginning of symptoms, location, and size of the fistulas, rate of success and recurrence with the use of endorectal flap, and need for complementary sphincteroplasty were all evaluated.
Results:
Median age of the patients was 25.6 years. All women reported that their symptoms began after a vaginal delivery that included an episiotomy or 4th degree laceration. All fistulas were low and small (<2.5 cm in diameter). Patients received bowel preparation and underwent rectovaginal repair using endorectal advancement flap. In two cases, additional overlap repair of the anal sphincter was performed. Result of repair was good to excellent in 15 patients (93.7%). There were no operative mortalities, and no covering stomas were used.
Conclusions:
Endorectal flap repair provides successful postobstetric rectovaginal fistula closure. Concomitant sphincteroplasty may be necessary in some cases.
