Techniques in Coloproctology

, Volume 6, Issue 1, pp 37–42

The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition

  • D. D. E. Zimmerman
  • M. P. Gosselink
  • J. W. Briel
  • W. R. Schouten
ORIGINAL ARTICLE

DOI: 10.1007/s101510200007

Cite this article as:
Zimmerman, D., Gosselink, M., Briel, J. et al. Tech Coloproctol (2002) 6: 37. doi:10.1007/s101510200007

Abstract

Transanal advancement flap repair (TAFR) has been advoated as the treatment of choice for patients with low rectovaginal fistulas. Recently, several studies have reported a significantly lower healing rate. We also encountered low healing rates after TAFR. In an attempt to improve our results, we added labial fat flap transposition (LFFT) to the TAFR of rectovaginal fistulas. The aim of the present study was to evaluate the outcome after TAFR and to investigate the impact of an additional LFFT. Between 1991 and 1997, 21 consecutive patients of median age 33 years underwent TAFR. The etiology of the fistulas was: obstetric injury (n=9), cryptoglandular abscess (n=8) and wound infection after anterior anal repair (n=4). The first 9 patients underwent TAFT with (n=3) or without (n=6) anterior anal repair. In the following 12 patients, LFFT was added to the advancement flap. In 4 of these a concomitant anterior anal repair was performed. The median follow-up was 15 months. The overall healing rate was 48%. In the first 9 patients, in whom no additional LFFT was performed, the rectovaginal fistula healed in 4 cases (44%). In the following 12 patients in whom an additional LFFT was performed, a similar healing rate was observed (50%). In conclusion, the outcome of transanal advancement flap repair of rectovaginal fistulas is poor. Addition of a labial fat flap transposition does not improve this outcome.

Key words Rectovaginal fistula Advancement flap Sphincteroplasty Labial fat flap 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • D. D. E. Zimmerman
    • 1
  • M. P. Gosselink
    • 1
  • J. W. Briel
    • 1
  • W. R. Schouten
    • 1
  1. 1.Colorectal Research Group, Department of Surgery, H1043 Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. colorectal.research@wxs.nlThe Netherlands

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