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The Noble-Mengert-Fish operation-revisited: a composite approach for persistent rectovaginal fistulas and complex
D K Veronikis1, D H Nichols, C Spino
1Section of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, St John's Mercy Medical Center, St Louis, Missouri, USA.
Objective:
Our aims were to evaluate the full-thickness anterior rectal wall advancement flap in the treatment of primary and recurrent or persistent rectovaginal fistulas, evaluate the surgical exposure for composite repair of site-specific perineal defects, and categorize clinical manifestations of site-specific perineal defects caused by obstetric injury.
Study Design:
This is a prospective study of all patients with fecal incontinence from rectovaginal septal defects and complex perineal obstetric injuries treated by the Noble-Mengert-Fish operation.
Results:
Thirty-four patients were classified into groups on the basis of site-specific perineal defects. Anatomic success was 94.2%. Functional success was excellent in 76.5%, good in 14.7%, fair in 5.9%, and poor in 2.9%.
Conclusion:
The Noble-Mengert-Fish operation is effective for primary and recurrent or persistent rectovaginal fistulas. The circumanal surgical exposure permits concomitant repair of all perineal defects.