Abstract
We report on a new and simple operative technique for closure of anovaginal fistulas with an anocutaneous flap in patients with Crohn' disease. From January 1989 till December 1990 this operation was performed in 10 women with Crohn's disease. Seven of the ten patients suffered from Crohn's proctitis. In these patients a protective enterostomy was applied before the operative closure of the fistula. All fistulas healed primarily. Within a median follow up of 18 months (7–24 months) a relapse occurred in 3 patients; two of these were treated success-fully with fibrin injection in one case and a further operative closure of the fistula using the same procedure in the second case. In the third patient a seton was placed into the recurrent fistula track, which is still present after 4 weeks.
Résumé
Nous rapportons une nouvelle technique opératoire simple de fermeture des fistules ano-vaginales avec un lambeau ano-cutané chez les patients atteints de maladie de Crohn. De janvier 1989 à Décembre 1990 cette opération a été réalisée chez 10 femmes avec une maladie de Crohn. 7 des 10 patients avaient une rectite de Crohn. Chez ces patients une colostomie de protection a été utilisée avant la fermeture chirurgicale de la fistule. Toutes les fistules ont guéri de première intention. Avec un recul moyen de 18 mois (7–24 mois) une récurrence est survenue chez 3 patientes. 2 d'entre-elles ont été traitées avec succés par des injections de Fibrine dans un cas et une seconde opération de fermeture par la même technique dans le deuxième cas. Chez la troisième malade un séton a été placé dans le trajet fistuleux récurrent qui est encore présent après 4 semaines.
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References
Hellers G, Bergstrand O, Ewerth S, Holmström B (1980) Occurence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 21:525–527
Hobbiss JH, Schofield PF (1982) Management of perianal Crohn's disease. J R Soc Med 75:414–417
Markowitz J, Daum F, Aiges H, Kahn E, Silverberg M, Fisher SE (1984) Perianal disease in children and adolescent with Crohn's disease. Gastroenterology 86:829–833
Malchow H (1985) Fisteln beim Morbus Crohn-Konservative versus operative Behandlung. Z Gastroenterol 23:28–33
Marks CG (1990) Anal lesions in Crohn's disease. Annals of the Royal College of Surgeons of England 72:158–159
Kruis W, Scheuchenstein AM, Scheurlen C, Weinzierl M (1989) Risikofaktoren für die Entstehung von Fisteln bei Morbus Crohn. Z Gastroenterol 27:313–316
Bagby RJ, Clements JL, Patrick JW (1973) Genitourinary complications of granulomatous bowel disease. AJR 117:297–303
Morrison JG, Gathright JB, Ray JE, Ferrari BT, Hicks TC, Timmcke AE (1989) Results of operation for rectovaginal fistula in Crohn's disease. Dis Colon Rectum 32:497–499
Tuxen PA, Castro AF (1979) Rectovaginal fistula in Crohn's disease. Dis Colon Rectum 22:58–62
Givel JC, Hawker P, Allan RN, Alexander-Williams J (1982) Enterovaginal fistulas associated with Crohn's disease. Surg Gynec Obstet 155:494–496
Athanasiadis S, Girona J (1983) Neue Behandlungsmethoden der perianalen Fisteln bei Morbus Crohn. Langenbecks Arch Chir 360:119–132
Bondy LC, Addison A, Parker RT (1983) Surgical management of rectovaginal fistulas in Crohn's disease. Am J Obstet Gynecol 147:359–363
Farkas AM, Gingold BS (1983) Repair of rectovaginal fistula in Crohn's disease by rectal mucosal advancement flap. Mount Sinai J Med 50:420–423
Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JMA (1988) Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 31:94–99
Rothenberger DA, Goldberg SM (1983) The Management of rectovaginal fistulae. Surg Clin North Am 63:61–79
Francois Y, Descos L, Vignal J (1990) Conservative treatment of low rectovaginal fistula in Crohn's disease. Int J Colorect Dis 5:12–14
Buls JG, Rothenberger DA (1985) Anal and rectovaginal fistulas: repair of the low fistula. In: Kodner IJ, Fry RD, Roe JP (eds) Colon, rectal and anal surgery: current technique and controversies. CV Mosby, St Louis 63–75
Rothenberger DA, Christenson CE, Balcos EG, Schottler JL, Nemer FD, Nivatvongs S, Goldberg S (1982) Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum 25:297–300
Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I (1991) Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease. Ann Surg 213:151–158
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Hesterberg, R., Schmidt, W.U., Müller, F. et al. Treatment of anovaginal fistulas with an anocutaneous flap in patients with Crohn's disease. Int J Colorect Dis 8, 51–54 (1993). https://doi.org/10.1007/BF00341278
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DOI: https://doi.org/10.1007/BF00341278