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International Urogynecology Journal

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01-06-2016 | Clinical Opinion

Presentation and management of rectovaginal fistulas after delivery

Author: Christl Reisenauer

Published in: International Urogynecology Journal | Issue 6/2016

Abstract

Introduction

Obstetric trauma leading to rectovaginal fistula (RVF) formation results from perineal laceration and/or from prolonged ischemia and necrosis following obstructed labor. Due to modern obstetric care fistulas are rare in industrialized countries.

Methods

Patients undergoing surgery for a RVF between January 2005 and December 2014 at the Department of Obstetrics and Gynecology, Tuebingen, Germany, were identified and their records were reviewed retrospectively.

Results

Of 48 patients, 13 developed RVF of obstetric etiology. Parity ranged from 2 to 4. RVF repair was performed in all patients using a transvaginal approach: fistula excision and multilayer closure (7 of 13) with Martius flap interposition (1 of 7) and sphincteroplasty (5 of 13). One RVF closed spontaneously. Due to significant destruction of the anal canal, large RVF and RVF recurrence, 4 of the 13 patients needed a temporary protective ileostomy. Fistula closure was achieved in 12 of 13 patients.

Conclusion

The choice of RVF repair should be tailored to the underlying pathology and type of repair done previously and the patient’s wishes

Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T (2009) Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet 107:12–15CrossRefPubMed

Melah GS, Massa AA, Yahaya UR, Bukar M, Kizaya DD, El Nafaty AU (2007) Risk factors for obstetric fistulae in north-eastern Nigeria. J Obstet Gynaecol 27:819–823CrossRefPubMed

Saclarides TJ (2002) Rectovaginal fistula. Surg Clin N Am 82:1261–1272CrossRefPubMed

Angioli R, Gomez-Marin O, Cantuaria G, O’Sullivan MJ (2000) Severe perineal lacerations during vaginal delivery; the University of Miami experience. Am J Obstet Gynecol 182:1083–1085CrossRefPubMed

Statistisches Bundesamt Deutschland. Gesundheitsberichterstattung des Bundes. www.gbe-bund.de

Hotouras A, Ribas Y, Zakeri S, Murphy J, Bhan C, Chan CL (2014) Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review. Color Dis 17:104–110CrossRef

Stock L, Basham E, Gossett DR, Lewicky-Gaupp C (2013) Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol 208:327.e1–327.e6CrossRef

Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, Kenton K, Gossett DR (2015) Wound complications after obstetric anal sphincter injuries. Obstet Gynecol 125:1088–1093CrossRefPubMed

Wall LL, Arrowssmith SD, Briggs ND, Browning A, Lassey A (2005) The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv 60(7 Suppl 1):3–51CrossRef

10.

Rahman MS, Al-Suleiman SA, El-Yahia AR, Rahman J (2003) Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years’ experience in a teaching hospital. J Obstet Gynaecol 23:607–610CrossRefPubMed

11.

Ommer A, Herold A, Berg E, Fuerst A, Schiedeck T, Sailer M (2012) German S3-Guideline: rectovaginal fistula. Ger Med Sci 10:Doc15PubMedPubMedCentral

12.

Schwandner O, Fuerst A, Kunstreich K, Scherer R (2009) Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 13:135–140CrossRefPubMed

13.

Moore RD, Miklos JR, Kohli N (2004) Rectovaginal fistula repair using a porcine dermal graft. Obstet Gynaecol 104:1165–1167CrossRef

14.

Russel TR, Gallagher DM (1977) Low rectovaginal fistulas. Approach and treatment. Am J Surg 134:13–18CrossRef

15.

Wise WE Jr, Aguilar PS, Padmanabhan A, Meesig DM, Arnold MW, Stewart WR (1991) Surgical treatment of low rectovaginal fistulas. Dis Colon Rectum 34:271–274CrossRefPubMed

16.

Tsang CB, Madoff RD, Wong WD, Rothenberger DA, Fine CO, Singer D, Lowry AC (1998) Anal sphincter integrity and function influences outcomes in rectovaginal fistula repair. Dis Colon Rectum 41:1141–1146CrossRefPubMed

17.

Khanduja KS, Padmanabhan A, Kerner BA, Wise WE, Aguilar PS (1999) Reconstruction of rectovaginal fistula with sphincter disruption combining rectal mucosal advancement flap and anal sphincteroplasty. Dis Colon Rectum 42:1432–1437CrossRefPubMed

Title: Presentation and management of rectovaginal fistulas after delivery
Author: Christl Reisenauer
Publication date: 01-06-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 6/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2860-0

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Presentation and management of rectovaginal fistulas after delivery

Abstract

Introduction

Methods

Results

Conclusion

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Abstract

Introduction

Methods

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Conclusion

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