Skip to main content
Top
Published in: International Journal of Colorectal Disease 11/2009

01-11-2009 | Review

Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas

Authors: Long Cui, Dawei Chen, Wei Chen, Honghua Jiang

Published in: International Journal of Colorectal Disease | Issue 11/2009

Login to get access

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.
Literature
1.
go back to reference Lescher TC, Pratt JH (1967) Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 124:1317–1321PubMed Lescher TC, Pratt JH (1967) Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 124:1317–1321PubMed
2.
go back to reference Goldaber KG, Wendel PJ, McIntire DD, Wendel GD Jr (1993) Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol 168:489–493PubMed Goldaber KG, Wendel PJ, McIntire DD, Wendel GD Jr (1993) Postpartum perineal morbidity after fourth-degree perineal repair. Am J Obstet Gynecol 168:489–493PubMed
3.
go back to reference Greenwald JC, Hoexter B (1978) Repair of rectovaginal fistulas. Surg Gynecol Obstet 146:443–445PubMed Greenwald JC, Hoexter B (1978) Repair of rectovaginal fistulas. Surg Gynecol Obstet 146:443–445PubMed
4.
go back to reference Schuman P, Christensen C, Sobel JD (1996) Aphthous vaginal ulceration in two women with acquired immunodeficiency syndrome. Am J Obstet Gynecol 174:1660–1663PubMedCrossRef Schuman P, Christensen C, Sobel JD (1996) Aphthous vaginal ulceration in two women with acquired immunodeficiency syndrome. Am J Obstet Gynecol 174:1660–1663PubMedCrossRef
5.
go back to reference Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM (1988) Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 31:94–99PubMedCrossRef Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM (1988) Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 31:94–99PubMedCrossRef
6.
go back to reference 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 9:201–206PubMedCrossRef 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 9:201–206PubMedCrossRef
7.
go back to reference 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 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
8.
go back to reference 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 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
9.
go back to reference 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 11:128–134PubMedCrossRef 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 11:128–134PubMedCrossRef
10.
go back to reference MacRae HM, McLeod RS, Cohen Z, Stern H, Reznick R (1995) Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 38:921–925PubMedCrossRef MacRae HM, McLeod RS, Cohen Z, Stern H, Reznick R (1995) Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 38:921–925PubMedCrossRef
11.
go back to reference 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 599PubMedCrossRef 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 599PubMedCrossRef
12.
go back to reference Palanivelu C, Rangarajan M, Sethilkumar R, Madankumar MV, Kalyanakumari V (2007) Laparoscopic management of iatrogenic high rectovaginal fistulas (Type VI). Singapore Med J 48:e96–98PubMed Palanivelu C, Rangarajan M, Sethilkumar R, Madankumar MV, Kalyanakumari V (2007) Laparoscopic management of iatrogenic high rectovaginal fistulas (Type VI). Singapore Med J 48:e96–98PubMed
13.
go back to reference Rabau M, Zmora O, Tulchinsky H, Gur E, Goldman G (2006) Recto-vaginal/urethral fistula: repair with gracilis muscle transposition. Acta Chir Iugosl 53:81–84PubMedCrossRef Rabau M, Zmora O, Tulchinsky H, Gur E, Goldman G (2006) Recto-vaginal/urethral fistula: repair with gracilis muscle transposition. Acta Chir Iugosl 53:81–84PubMedCrossRef
14.
go back to reference 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 9:653–656PubMedCrossRef 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 9:653–656PubMedCrossRef
15.
go back to reference 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 46:49–51PubMedCrossRef 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 46:49–51PubMedCrossRef
16.
go back to reference McDonald PJ, Bona R, Cohen CR (2004) Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis 6:64–65PubMedCrossRef McDonald PJ, Bona R, Cohen CR (2004) Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis 6:64–65PubMedCrossRef
17.
go back to reference Angelone G, Giardiello C, Prota C (2006) Stapled hemorrhoidopexy. Complications and 2-year follow-up. Chir Ital 58:753–760PubMed Angelone G, Giardiello C, Prota C (2006) Stapled hemorrhoidopexy. Complications and 2-year follow-up. Chir Ital 58:753–760PubMed
18.
go back to reference Tsutsumi N, Yoshida Y, Maehara Y, Kohnoe S (2007) Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer. Hepatogastroenterology 54:1682–1683PubMed Tsutsumi N, Yoshida Y, Maehara Y, Kohnoe S (2007) Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer. Hepatogastroenterology 54:1682–1683PubMed
19.
go back to reference Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C (2001) Repair of recurrent rectovaginal fistulas. Surgery 130:753–757 discussion 757-758PubMedCrossRef Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C (2001) Repair of recurrent rectovaginal fistulas. Surgery 130:753–757 discussion 757-758PubMedCrossRef
20.
go back to reference Baig MK, Zhao RH, Yuen CH, Nogueras JJ, Singh JJ, Weiss EG, Wexner SD (2000) Simple rectovaginal fistulas. Int J Colorectal Dis 15:323–327PubMedCrossRef Baig MK, Zhao RH, Yuen CH, Nogueras JJ, Singh JJ, Weiss EG, Wexner SD (2000) Simple rectovaginal fistulas. Int J Colorectal Dis 15:323–327PubMedCrossRef
21.
go back to reference 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 22:1051–1060PubMedCrossRef 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 22:1051–1060PubMedCrossRef
22.
go back to reference 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 23:349–353PubMedCrossRef 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 23:349–353PubMedCrossRef
23.
go back to reference 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 22:259–264PubMedCrossRef 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 22:259–264PubMedCrossRef
24.
go back to reference 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 41:1141–1146PubMedCrossRef 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 41:1141–1146PubMedCrossRef
Metadata
Title
Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas
Authors
Long Cui
Dawei Chen
Wei Chen
Honghua Jiang
Publication date
01-11-2009
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 11/2009
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-009-0720-4

Other articles of this Issue 11/2009

International Journal of Colorectal Disease 11/2009 Go to the issue