International Journal of Colorectal Disease

, Volume 23, Issue 4, pp 349–353

Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease

Authors

    • Department of SurgeryCaritas-Clinic St. Josef
  • Christin Schmidbauer
    • Department of SurgeryCaritas-Clinic St. Josef
  • Justyna Swol-Ben
    • Department of SurgeryUniversity of Regensburg
  • Igors Iesalnieks
    • Department of SurgeryUniversity of Regensburg
  • Oliver Schwandner
    • Department of SurgeryCaritas-Clinic St. Josef
  • Ayman Agha
    • Department of SurgeryUniversity of Regensburg
Original Article

DOI: 10.1007/s00384-007-0413-9

Cite this article as:
Fürst, A., Schmidbauer, C., Swol-Ben, J. et al. Int J Colorectal Dis (2008) 23: 349. doi:10.1007/s00384-007-0413-9

Abstract

Objective

Local surgical procedures in the presence of Crohn’s disease have a markedly reduced success rate, especially in the treatment of recurrent anovaginal and distant rectovaginal fistulas. In these patients, local surgery (e.g., flap closure) has unsatisfactory results if the anal canal is destroyed by ulceration and indurations or in patients with extensive defects of the perineum.

Materials and methods

Over a period of 6 years (2000 to 2006), 12 patients with recurrent rectovaginal fistulas were treated with graciloplasty. The age of the female patients ranged from 24 to 47 years, the mean age being 38 years. The presence of Crohn’s disease in all patients had a mean duration of 12 years. Corticosteroids, mesalazin, or azathioprin were administered preoperatively. All patients were diverted by a temporary ileostomy before graciloplasty.

Results

Rectovaginal fistula was closed in 11 of 12 patients after graciloplasty with a mean follow-up of 3.4 years. One rerecurrence of a rectovaginal fistula was documented. One of 12 ileostomies was not closed due to persistence of the fistula tract. One patient had a pouch-anal and, additionally, a pouch-vaginal fistula. In this patient, the first transposition of the gracilis muscle was unsuccessful. After a few months, she underwent renewed graciloplasty. There was no recurrence of a fistula within the follow-up period. Reconstruction of the perineum constituted an additional positive effect of the graciloplasty. In one patient, the preexisting fecal incontinence persisted, even after secondary implantation of a pacemaker. Due to diarrhea and persistent fecal incontinence, the patient opted for a renewed ileostomy.

Conclusions

In our series, gracilis transposition in the treatment of recurrent anovaginal and rectovaginal fistulas in patients with Crohn’s disease has excellent short-term results. In addition, graciloplasty can reconstruct the perineal defect.

Keywords

GraciloplastyRecurrent fistulaAnovaginalRectovaginalCrohn’s disease

Copyright information

© Springer-Verlag 2007