Résumé
La prise en charge chirurgicale des fistules rectovaginales hautes est complexe et répond à plusieurs principes. Le traitement est tout d’abord fonction de l’étiologie de la fistule, notamment la prise en charge d’une maladie de Crohn associée. L’arsenal thérapeutique est très varié et constitue une véritable «escalade», allant du simple drainage par séton en cas de sepsis local, le recours aux lambeaux d’avancement rectal et/ou musculaire jusqu’au traitement radical en cas d’échec ou de récidive que représente l’exérèse du rectum avec colostomie ou plus souvent iléostomie définitive. Par contre, lors d’un geste de réparation de la fistule, une stomie temporaire de dérivation des selles est souvent nécessaire afin de favoriser la cicatrisation locale. Les résultats dépendent de l’étiologie de la fistulemais restent globalement bons avec un espoir de guérison dans plus des deux tiers des cas.
Abstract
The surgical approach to complex rectovaginal fistulas varies and depends on a number of factors, including the aetiology of the fistula, its site and, most importantly, its association with Crohn’s disease. A variety of surgical options exists, such as local repair procedures (advancement flap and muscle transposition) and abdominal procedures (rectal excision with temporary or permanent stoma). Faecal diversion is a determinant factor for healing. After preoperative evaluation of the best treatment options, most fistulas can be successfully repaired in two-thirds of patients.
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Bretagnol, F., Alves, A. & Panis, Y. Traitement chirurgical des fistules rectovaginales hautes. Pelv Perineol 2, 275–279 (2007). https://doi.org/10.1007/s11608-007-0148-7
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DOI: https://doi.org/10.1007/s11608-007-0148-7