Abstract
Objective
The objective of the study is to assess the efficacy of vital bulbocavernosus graft transposition in the treatment of rectovaginal fistula.
Materials and methods
From March 2003 to October 2007, nine consecutive patients diagnosed with rectovaginal fistula were refereed to our institute. All patients were treated using an interposing vital bulbocavernosus graft between rectum and vagina.
Results
Median patient age was 33 years (range, 19–61) and seven of the nine patients had undergone between one and six fistula repair sessions prior to this grafting procedure. The etiology included congenital in three, surgery injury in four, obstetric in one, and radiation in one. No wound infections or abscesses occurred postoperatively, and the in-hospital mortality rate was zero. No recurrence was reported during the follow-up period and all patients had normal fecal continence. Only one patient had mild dyspareunia and no further surgical treatment needed.
Conclusion
Both simple and complex rectovaginal fistula can be reliably repaired using a bulbocavernosus graft.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lescher TC, Pratt JH (1967) Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 124:1317–1321
Goldaber KG, Wendel PJ, McIntire DD, Wendel GD Jr (1993) Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol 168:489–493
Greenwald JC, Hoexter B (1978) Repair of rectovaginal fistulas. Surg Gynecol Obstet 146:443–445
Schuman P, Christensen C, Sobel JD (1996) Aphthous vaginal ulceration in two women with acquired immunodeficiency syndrome. Am J Obstet Gynecol 174:1660–1663
Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM (1988) Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 31:94–99
de Dombal FT, Watts JM, Watkinson G, Goligher JC (1966) Incidence and management of anorectal abscess, fistula and fissure, in patients with ulcerative colitis. Dis Colon Rectum 9:201–206
Gordon PH (1992) Rectovaginal fistula. In: Gordon PH, Nivatvongs S (eds) Principles and Practice of Surgery for the Colon, Rectum and Anus, 3rd edn. Informa HealthCare, NewYork and London, pp 333–352
Corman ML (2004) Rectovaginal and rectourethral fistulas. In: Corman ML (ed) Colon and Rectal surgery, 5th edn. Lippincott williams and wilkins, Philadelphia, pp 333–346
Devesa JM, Devesa M, Velasco GR, Vicente R, Garcia-Moreno F, Rey A, Lopez-Hervas P, Die J, Molina JM (2007) Benign rectovaginal fistulas: management and results of a personal series. Tech Coloproctol 11:128–134
MacRae HM, McLeod RS, Cohen Z, Stern H, Reznick R (1995) Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 38:921–925
McNevin MS, Lee PY, Bax TW (2007) Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg 193:597–599 discussion 599
Palanivelu C, Rangarajan M, Sethilkumar R, Madankumar MV, Kalyanakumari V (2007) Laparoscopic management of iatrogenic high rectovaginal fistulas (Type VI). Singapore Med J 48:e96–98
Rabau M, Zmora O, Tulchinsky H, Gur E, Goldman G (2006) Recto-vaginal/urethral fistula: repair with gracilis muscle transposition. Acta Chir Iugosl 53:81–84
Songne K, Scotte M, Lubrano J, Huet E, Lefebure B, Surlemont Y, Leroy S, Michot F, Teniere P (2007) Treatment of anovaginal or rectovaginal fistulas with modified Martius graft. Colorectal Dis 9:653–656
Casadesus D, Villasana L, Sanchez IM, Diaz H, Chavez M, Diaz A (2006) Treatment of rectovaginal fistula: a 5-year review. Aust N Z J Obstet Gynaecol 46:49–51
McDonald PJ, Bona R, Cohen CR (2004) Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis 6:64–65
Angelone G, Giardiello C, Prota C (2006) Stapled hemorrhoidopexy. Complications and 2-year follow-up. Chir Ital 58:753–760
Tsutsumi N, Yoshida Y, Maehara Y, Kohnoe S (2007) Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer. Hepatogastroenterology 54:1682–1683
Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C (2001) Repair of recurrent rectovaginal fistulas. Surgery 130:753–757 discussion 757-758
Baig MK, Zhao RH, Yuen CH, Nogueras JJ, Singh JJ, Weiss EG, Wexner SD (2000) Simple rectovaginal fistulas. Int J Colorectal Dis 15:323–327
Athanasiadis S, Yazigi R, Kohler A, Helmes C (2007) Recovery rates and functional results after repair for rectovaginal fistula in Crohn's disease: a comparison of different techniques. Int J Colorectal Dis 22:1051–1060
Furst A, Schmidbauer C, Swol-Ben J, Iesalnieks I, Schwandner O, Agha A (2008) Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn's disease. Int J Colorectal Dis 23:349–353
Uribe N, Millan M, Minguez M, Ballester C, Asencio F, Sanchiz V, Esclapez P, del Castillo JR (2007) Clinical and manometric results of endorectal advancement flaps for complex anal fistula. Int J Colorectal Dis 22:259–264
Tsang CB, Madoff RD, Wong WD, Rothenberger DA, Finne CO, Singer D, Lowry AC (1998) Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 41:1141–1146
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cui, L., Chen, D., Chen, W. et al. Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas. Int J Colorectal Dis 24, 1255–1259 (2009). https://doi.org/10.1007/s00384-009-0720-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-009-0720-4