Skip to main content

Advertisement

SpringerLink
Log in

Rectovaginal Fistula: A New Approach By Stapled Transanal Rectal Resection

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Many surgical procedures have been developed to repair rectovaginal fistulas even if no “procedure of choice” is reported. The authors report a case of relatively uncommon, complex, medium-high post-obstetric rectovaginal fistula without sphincteral lesions and treated with a novel tailored technique. Our innovative surgical management consisted of preparing the neck of the fistula inside the vagina and folding it into the rectum so as to enclose the fistula within two semicontinuous sutures (stapled transanal rectal resection); no fecal diversion was performed. Postoperative follow-up at 9 months showed no recurrence of the fistula.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Baig MK, Zhao RH, Yuen CH, Nogueras JJ, Singh JJ, Weiss EG, Wexner SD. Simple rectovaginal fistulas. Int J Colorectal Dis 2000;15:323–327.

    Article  PubMed  CAS  Google Scholar 

  2. Tsang CB, Madoff RD, Wong WD, Rothenberger DA, Finne CO, Singer D, Lowry AC. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 1998;41:1141–1146.

    Article  PubMed  CAS  Google Scholar 

  3. Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA. Anorectal complications of vaginal delivery. Dis Colon Rectum 1989;32:1039–1041.

    Article  PubMed  CAS  Google Scholar 

  4. Naru T, Rizvi JH, Talati J. Surgical repair of genital fistulae. J Obstet Gynaecol Res 2004;30:293–296.

    Article  PubMed  Google Scholar 

  5. Bangser M. Obstetric fistula and stigma. Lancet 2006;367:535–536.

    Article  PubMed  Google Scholar 

  6. Donnay F. Weil L. Obstetric fistula: the international response. Lancet 2004;363:71–72.

    Article  PubMed  Google Scholar 

  7. Oom DM, Gosselink MP, Van Dijl VR, Zimmerman DD, Schouten WR. Puborectal sling interposition for the treatment of rectovaginal fistulas. Tech Coloproctology 2006;10:125–130.

    Article  CAS  Google Scholar 

  8. Charua Guindic L, Retama Velasco L, Avendano Espinosa O. Management of the rectovaginal fistula. A review of five years at the Colon and Rectal Unit of the General Hospital of Mexico City. Ginecol Obstet Mex 2004;72:209–214.

    PubMed  Google Scholar 

  9. Chew SS, Rieger NA. Transperineal repair of obstetric-related anovaginal fistula. Aust N Z J Obstet Gynaecol 2004;44:68–71.

    Article  PubMed  Google Scholar 

  10. Zimmerman DD, Gosselink MP, Briel JW, Schouten WR. The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition. Tech Coloproctology 2002;6:37–42.

    Article  CAS  Google Scholar 

  11. Yee LF, Birnbaum EH, Read TE, Kodner IJ, Fleshman JW. Use of endoanal ultrasound in patients with rectovaginal fistulas. Dis Colon Rectum 1999;42:1057–1064.

    Article  PubMed  CAS  Google Scholar 

  12. Shelton AA, Welton ML. Transperineal repair of persistent rectovaginal fistulas using an acellular cadaveric dermal graft (AlloDerm). Dis Colon Rectum 2006;49:1454–1457.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  14. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905–1911.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M. Gracilis muscle transposition for fistulas between the rectum and urethra or vagina. Dis Colon Rectum 2006;49:1316–1321.

    Article  PubMed  Google Scholar 

  17. Noble GH. A new operation for complete laceration of the perineum designed for the purpose of eliminating danger of infection for the rectum. Trans Am Gynecol Soc 1902;27:357–363.

    Google Scholar 

  18. Greenwald JC, Hoexter B. Repair of rectovaginal fistulas. Surg Gynecol Obstet 1978;146:443–445.

    PubMed  CAS  Google Scholar 

  19. Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection (STARR). 2004 Annual Cleveland Clinic Florida Colorectal Disease Symposium.

  20. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 2002;45:1622–1628.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Authors wish to thank Mrs. Grazia Strazzeri for the artwork.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, Organ Transplantation, Advanced Technologies, University of Catania, Via Guicciardini 6, 95030, Sant’Agata Li Battiati, Catania, Italy

    Giovanni Li Destri & Beniamino Scilletta

  2. Department of Obstetric and Gynecology, Radiology, and Anesthesiology, University of Catania, Catania, Italy

    Tiziana Grazia Tomaselli & Giuseppe Zarbo

Authors
  1. Giovanni Li Destri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beniamino Scilletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tiziana Grazia Tomaselli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Zarbo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Li Destri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li Destri, G., Scilletta, B., Tomaselli, T.G. et al. Rectovaginal Fistula: A New Approach By Stapled Transanal Rectal Resection. J Gastrointest Surg 12, 601–603 (2008). https://doi.org/10.1007/s11605-007-0333-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0333-6

Keywords

Search

Navigation