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Botulinum Toxin Injection for the Treatment of the Recurrent Rectovaginal Fistulas in Combination with Surgical Repair

  • Surgical Techniques and Innovations
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Rectovaginal fistula is abnormal connections between the vagina and rectum. Via this connection, the passages of flatus or stool from rectum to vagina occur. Patient history and physical examination are usually enough to make diagnosis of fistula. Although there are so many defined surgical options including sphincteroplasty, advanced flap, muscle interposition, fibrin glue, plugs, and closure of fistulas remain a challenging condition with the high rate failure of surgical repair In this study, we aim to report the results of a new treatment approach with the injection of botulinum toxin into lateral internal sphincter on the management of rectovaginal fistula in conjunction with the surgical repair. Between 2013 and 2019, 8 patients with recurrent rectovaginal fistula underwent 10 surgical repairs in conjunction with 100 units botulinum toxin injection. Results of these patients were analyzed. We have treated 8 patients with recurrent rectovaginal fistula. The etiology of fistula in our patients included obstetrical trauna (3 patients), radiotherapy and rectal surgery (2 patients), vaginal reconstruction (2 patients) and Crohn’s disease (1 patient). The median number of their previous operations was 1.5 (range, 1–3). The sizes of fistulas range from 0.5 × 1 to 2 × 3 cm. In our surgical intervention, at the end, all of them were closed (100%) successfully. Botulinum toxin injection into lateral internal sphincter can be used successfully in combination with surgical intervention for the treatment of the rectovaginal fistulas.

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Abbreviations

BMI:

body mass index

RVF:

rectovaginal fistula

TVR:

transvaginal repair

ERAF:

endorectal advancement flap

BTX:

botulinum toxin

RT:

radiation therapy

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Authors and Affiliations

  1. General Surgery Department, VM Medicalpark Ankara Private Hospital, Yüksek Ihtisas University, 06800, Ankara, Turkey

    Fahri Yetisir

  2. Department of General Surgery, Near East University Faculty of Medicine, 99138, Nicosia, Turkey

    Kerim Güzel

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  1. Fahri Yetisir
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  2. Kerim Güzel
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Correspondence to Fahri Yetisir.

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Yetisir, F., Güzel, K. Botulinum Toxin Injection for the Treatment of the Recurrent Rectovaginal Fistulas in Combination with Surgical Repair. Indian J Surg 84, 190–194 (2022). https://doi.org/10.1007/s12262-021-02823-0

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  • DOI: https://doi.org/10.1007/s12262-021-02823-0

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