Abstract
Rectovaginal fistula [RVF] is a devastating complication of anterior resection whose incidence worldwide is on a rise with widespread use of staplers for the rectal anastomosis. It is a special surgical challenge for the treating surgeon with limited suitable options available to treat this difficult situation. As there is no consensus on its management, most often patient ends up with permanent stoma and overall inferior quality of life. We are presenting a case of post anterior resection RVF which was treated with intersphincteric resection followed by hand sewn coloanal anastomosis. An intersphincteric resection avoids dissection in a previously violated rectovaginal plane and improves chances of sphincter preservation. A well vascularized colonic graft with hand sewn coloanal anastomoses well below the site of fistula and omental interposition further avoids the chances of recurrence of fistula.
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References
Sugarbaker PH (1996) Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer. J Surg Oncol 61(2):155–158
Baran JJ, Goldstein SD, Resnik AM (1992) The double-staple technique in colorectal anastomoses: a critical review. Am Surg 58(4):270–272
Matthiessen P, Hansson L, Sjödahl R, Rutegård J (2010) Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer–occurrence and risk factors. Colorectal Dis 12(4):351–357
Shin US, Kim CW, Yu CS, Kim JC (2010) Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Colorectal Dis 25(7):843–849
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T et al (2011) Cryptoglandular anal fistulas. Dtsch Arztebl Int 108(42):707–713
Rex JC, Khubchandani IT (1992) Rectovaginal fistula: complication of low anterior resection. Dis Colon Rectum 35(4):354–356
Pitel S, Lefevre JH, Parc Y, Chafai N, Shields C, Tiret E (2011) Martius advancement flap for low rectovaginal fistula: short- and long-term results. Colorectal Dis 13(6):e112–e115
Cui L, Chen D, Chen W, Jiang H (2009) Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas. Int J Colorectal Dis 24(11):1255–1259
Pata G, Pasini M, Roncali S, Tognali D, Ragni F (2014) Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition. Int J Surg Case Rep 5(8):527–531
Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O (2008) Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg 248(1):39–43
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Pai, V., Desouza, A., De Menezes, J.L. et al. Rectovaginal Fistula with Anastomotic Stricture Post Anterior Resection – Sphincter Preservation, a Viable Option. Indian J Surg Oncol 6, 256–258 (2015). https://doi.org/10.1007/s13193-015-0398-8
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DOI: https://doi.org/10.1007/s13193-015-0398-8