Transanal rectovaginal fistula repair

Area of Science:

• Surgical Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Low rectovaginal fistulas present a complex surgical challenge, often requiring specialized techniques.
• Previous reports indicated success with transanal repair, but long-term outcomes and cost-efficiency improvements needed further evaluation.

Purpose of the Study:

• To update and extend the follow-up of patients undergoing transanal repair for low rectovaginal fistulas.
• To evaluate the long-term success rates and cost-efficiency of modified perioperative routines for this surgical approach.

Main Methods:

• A cohort of 35 patients with low rectovaginal fistulas (excluding inflammatory, neoplastic, or irradiation-related causes) underwent transanal repair.
• The surgical technique involved complete fistula excision, reapproximation of sphincter mechanisms, and rectal mucosal advancement.
• Perioperative routines were modified to enhance cost efficiency.

Main Results:

• An additional 15 patients were followed for one to six years postoperatively, adding to the initial 20 patients from a 1978 report.
• The transanal repair technique demonstrated uniformly successful outcomes in all 35 patients.
• Modified perioperative routines significantly enhanced cost efficiency.

Conclusions:

• Transanal repair remains a highly successful and cost-efficient surgical option for low rectovaginal fistulas without the need for colostomy.
• Long-term follow-up confirms the durability of this surgical approach.
• Modifications in perioperative routines further optimize the management of rectovaginal fistulas.