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Singh P, Kumar S, Panaiyadiyan S, Singh P, Dogra P, Seth A. Repair of Rectourethral Fistula Using Gracilis Muscle Flap Interposition—a Tertiary Care Center Experience. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Britto C, Pfalzgraf D, Lima R, Medeiros P, Rebouças R, Passerotti C. Video-Endoscopic Mobilization of the Gracilis Muscle for Rectourinary Fistula Repair. Urol Int 2021; 105:1123-1127. [PMID: 34120106 DOI: 10.1159/000515614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transposition of the gracilis has been used in a large number of reconstructive procedures. Its advantage is its proximity to these defects and a good blood supply. Traditionally, the gracilis mobilization is performed by open surgery with one or more incisions. We describe our initial experience with the video-endoscopic mobilization of gracilis. METHOD We described a retrospective review of all patients who underwent gracilis muscle mobilization for treatment of rectourethral fistula, performed by video-endoscopy, between March 2013 and September 2017, for treatment of rectourethral fistula. Also, our surgical technique is described in detail. RESULTS Three patients, with a mean age of 66.6 years, underwent the procedures. The mean time for mobilization of the gracilis was 107 min (range 60-145). There was no case of donor area infection, no change in the sensitivity of the medial aspect of the thigh or chronic pain. Conversion to open surgery was not necessary in any case. The hospital discharge occurred in average after 4 days. The bladder catheter was removed after 4 weeks after cystography was performed without evidence of leakage. One patient had a recurrence of the fistula. DISCUSSION The gracilis is an excellent choice of tissue to be interposed in reconstructive procedures of the perineal region, especially in the treatment of rectourinary fistulas. However, endoscopic harvest of the gracilis muscle has not yet found its way into everyday practice. The results in the treatment of rectourinary fistulas are excellent, with a success rate of 87.7%. Our rate of 67% is below, probably due to the small number of cases. In open surgery, complications are uncommon; however, approximately half of the patients expressed concern about the painful scar, which can be reduced by minimally invasive access. CONCLUSION Video-endoscopic mobilization of gracilis muscle for the treatment of rectourethral fistula is feasible and safe. Studies comparing this technique with the conventional mobilization are required.
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Affiliation(s)
- Cesar Britto
- Hospital Universitário Onofre Lopes, UFRN, Natal, Brazil
| | - Daniel Pfalzgraf
- University Medical Mannheim, Mannheim, Germany.,Heilig Geist Hospital Bensheim, Bensheim, Germany
| | | | - Paulo Medeiros
- Hospital Universitário Onofre Lopes, UFRN, Natal, Brazil
| | - Rafael Rebouças
- Hospital da Policia Militar Edson Ramalho, João Pessoa, Brazil.,Universidade de João Pessoa, UNIPE, João Pessoa, Brazil
| | - Carlo Passerotti
- Laboratório de Investigação Médica-Urologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica, São Paulo, Brazil
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Kersting S, Athanasiadis CJ, Jung KP, Berg E. Operative results, sexual function and quality of life after gracilis muscle transposition in complex rectovaginal fistulas. Colorectal Dis 2019; 21:1429-1437. [PMID: 31245912 DOI: 10.1111/codi.14741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
AIM Successful treatment of complex rectovaginal fistulas (RVFs) continues to be a surgical challenge. Interposition of well-perfused tissue, such as gracilis muscle, is one treatment option. The aim of this study was to investigate the operative results, sexual function and quality of life after gracilis muscle transposition (GMT) in the authors' own group of patients. METHOD The study included 19 women with RVF (mean age 48 years). The postoperative outcome was evaluated by a questionnaire and clinical examination. RESULTS The postoperative follow-up period was 7 months to 3.5 years (mean 23 months). GMT led to primary healing of RVF in 10 (53%) patients. Recurrences were observed in nine (47%) patients with RVF, in four (44%) of whom healing was achieved as a result of further interventions. Following GMT, two complications (abscess formation) requiring revision occurred. Although 42% of the patients reported certain limitations following muscle removal, GMT is a procedure that has a positive influence on the healing rate (74%), quality of life, continence and patient satisfaction. CONCLUSION GMT is a procedure that allows healing in the majority of patients with RVFs, and it should be considered especially in patients with recurrent fistulas, in whom a correlation between decreasing healing rates and the number of previous operations has been demonstrated.
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Affiliation(s)
- S Kersting
- Department of General Surgery, Katharinen-Hospital Unna, Unna, Germany
| | - C-J Athanasiadis
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - K-P Jung
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - E Berg
- Department of Coloproctology, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
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Jai S, Ganpule A, Singh A, Vijaykumar M, Bopaiah V, Sabnis R, Desai M. Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula. F1000Res 2017; 5:2891. [PMID: 28299181 PMCID: PMC5310386 DOI: 10.12688/f1000research.10245.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/29/2022] Open
Abstract
High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni
et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results. We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”.
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Affiliation(s)
- Shrikant Jai
- Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India
| | - Arvind Ganpule
- Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India
| | - Abhishek Singh
- Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India
| | | | - Vinod Bopaiah
- Staten Island University Hospital, Staten Island, USA
| | - Ravindra Sabnis
- Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India
| | - Mahesh Desai
- Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India
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Lalwani S, Varma V, Kumaran V, Mehta N, Nundy S. Complex Rectovaginal Fistula-an Experience at a Tertiary Care Centre. Indian J Surg 2015; 77:1142-7. [PMID: 27011526 DOI: 10.1007/s12262-015-1218-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/05/2015] [Indexed: 01/10/2023] Open
Abstract
Complex rectovaginal fistulae are difficult to manage. With an initial failed attempt, a simple fistula becomes complex and the success rate of a subsequent repair decreases. A review of our prospectively maintained records over a period of 16 years revealed 25 patients with rectovaginal fistulae. A variety of procedures was performed in these patients according to their aetiology, site and if there had been a previous attempt at repair. The mean age of the patients was 45 years. The most common cause was operative trauma in 14 cases. Ten patients had previous attempts at repair which had not been successful. The surgical procedures we performed included re-enforcement flaps, resection with diversion, repair with re-enforcement with omentum and simple diversion. Two patients developed recurrence, and one of them healed after a second repair. No recurrence developed in 10 patients who had failed attempts at repair elsewhere. Our experience has shown that most complex rectovaginal fistulae can be successfully repaired but they might require repeated operations. Faecal diversion is usually necessary, and in recurrent fistulae, we found that rather than a local repair, a muscle flap or omental interposition improves the chances of healing.
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Affiliation(s)
- Shailendra Lalwani
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, Room No 2222, New Delhi, 110060 India
| | - Vibha Varma
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, Room No 2222, New Delhi, 110060 India
| | - Vinay Kumaran
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, Room No 2222, New Delhi, 110060 India
| | - Naimish Mehta
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, Room No 2222, New Delhi, 110060 India
| | - Samiran Nundy
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, Room No 2222, New Delhi, 110060 India
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Takano S, Boutros M, Wexner SD. Gracilis Muscle Transposition for Complex Perineal Fistulas and Sinuses: A Systematic Literature Review of Surgical Outcomes. J Am Coll Surg 2014; 219:313-23. [DOI: 10.1016/j.jamcollsurg.2014.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/15/2014] [Indexed: 02/07/2023]
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Göttgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO. The disappointing quality of published studies on operative techniques for rectovaginal fistulas: a blueprint for a prospective multi-institutional study. Dis Colon Rectum 2014; 57:888-98. [PMID: 24901691 DOI: 10.1097/dcr.0000000000000147] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Treatment of rectovaginal fistulas is difficult, and many surgical interventions have been developed. The best surgical intervention for the closure of these fistulas is still unclear. OBJECTIVE A systematic review was performed reporting the outcomes of different surgical techniques for rectovaginal fistulas. DATA SOURCES Medline (PubMed, Ovid), Embase (Ovid), and The Cochrane Library databases were searched for eligible articles as well as the references of these articles. STUDY SELECTION Two independent reviewers analyzed the search results for eligible articles based on title, abstract, and described results. INTERVENTION(S) Any surgical intervention for the closure of rectovaginal fistulas was included. MAIN OUTCOME MEASURES The main outcome was closure rate. Secondary outcomes were quality of life, morbidity, and the effect on sexual functioning. RESULTS Many articles with different operative techniques were identified and classified in the following categories: advancement flaps (endorectal and endovaginal), transperineal closure, Martius procedure, gracilis muscle transposition, rectal resections, transabdominal closure, mesh repair, plugs, endoscopic repairs, closure with biomaterials, and miscellaneous techniques. Results vary widely with closure rates between 0% and >80%. None of the studies were randomized. Because of the poor quality of the identified studies, the comparison of results and performance of a meta-analysis were not possible.Data regarding the secondary outcomes were mostly unavailable. LIMITATIONS The major limitation of this review was the limited availability of high-quality prospective studies, making it impossible to perform a meta-analysis. CONCLUSIONS No conclusion about the best surgical intervention for rectovaginal fistulas could be formulated. More large studies of high quality are needed to find the best treatment for rectovaginal fistulas. A design for these high-quality studies was formulated.
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Affiliation(s)
- Kevin W Göttgens
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Chen XB, Wang YX, Jiang H, Liao DX, Yu JH, Luo CH. Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas. World J Gastroenterol 2013; 19:6625-6629. [PMID: 24151391 PMCID: PMC3801378 DOI: 10.3748/wjg.v19.i39.6625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/16/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs).
METHODS: Between May 2009 and March 2012, 11 female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled. Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage. Efficacy was assessed in terms of the success rate and surgical complications. SF-36 quality of life (QOL) scores and Wexner fecal incontinence scores were compared before and after surgery.
RESULTS: The fistulas healed in 14 patients after gracilis muscle transposition; the initial healing rate was 73.7%. Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5 patients: 4 healed and 1 failed, and postoperative fecal diversions were performed for the patient whose treatment failed. At a median follow-up of 17 mo, the overall healing rate was 94.7%. Postoperative complications occurred in 4 cases. Significant improvement was observed in the quality outcomes framework scores (P < 0.001) and Wexner fecal incontinence scores (P = 0.002) after the successful healing of complex RVFs or RUFs. There was no significant difference in SF-36 QOL scores between the initial healing group and irrigation-suction-assisted healing group.
CONCLUSION: Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs. QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.
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Ommer A, Herold A, Berg E, Farke S, Fürst A, Hetzer F, Köhler A, Post S, Ruppert R, Sailer M, Schiedeck T, Strittmatter B, Lenhard B, Bader W, Geschwend J, Krammer H, Stange E. S3-Leitlinie: Rektovaginale Fisteln (ohne M. Crohn): AWMF-Registriernummer: 088/004. coloproctology 2012; 34:211-46. [DOI: 10.1007/s00053-012-0287-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pescatori M. Rectovaginal Fistulae. Prevention and Treatment of Complications in Proctological Surgery 2012:85-97. [DOI: 10.1007/978-88-470-2077-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Pescatori M. Fistole retto-vaginali. Prevenzione e trattamento delle complicanze in chirurgia proctologica 2011:85-97. [DOI: 10.1007/978-88-470-2062-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Cui L, Chen D, Chen W, Jiang H. Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas. Int J Colorectal Dis 2009; 24:1255-9. [PMID: 19421760 DOI: 10.1007/s00384-009-0720-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2009] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of the study is to assess the efficacy of vital bulbocavernosus graft transposition in the treatment of rectovaginal fistula. MATERIALS AND METHODS From March 2003 to October 2007, nine consecutive patients diagnosed with rectovaginal fistula were refereed to our institute. All patients were treated using an interposing vital bulbocavernosus graft between rectum and vagina. RESULTS Median patient age was 33 years (range, 19-61) and seven of the nine patients had undergone between one and six fistula repair sessions prior to this grafting procedure. The etiology included congenital in three, surgery injury in four, obstetric in one, and radiation in one. No wound infections or abscesses occurred postoperatively, and the in-hospital mortality rate was zero. No recurrence was reported during the follow-up period and all patients had normal fecal continence. Only one patient had mild dyspareunia and no further surgical treatment needed. CONCLUSION Both simple and complex rectovaginal fistula can be reliably repaired using a bulbocavernosus graft.
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Affiliation(s)
- Long Cui
- Department of Colorectal Surgery, Shanghai XinHua Hospital Shanghai JiaoTong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China.
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Aydin F, Eisenberger CF, Raffel A, Rehders A, Hosch SB, Knoefel WT. Recurrent Fistula between Ileal Pouch and Vagina-Successful Treatment with a Gracilis Muscle Flap. Case Rep Med. 2009;2009:676392. [PMID: 19718250 PMCID: PMC2729290 DOI: 10.1155/2009/676392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 04/02/2009] [Indexed: 12/16/2022] Open
Abstract
Fistulae between an ileal pouch and the vagina are an uncommon complication of ileal pouch-anal anastomosis following proctocolectomy and mucosectomy in patients with familial adenomatous polyposis coli. Several reports describe the successful use of muscle flaps to close recurrent pouch-vaginal-fistulae (PVF). However, series only contain small numbers and an optimal management has not yet been determined. We report the case of a 26-year old woman with a third recurrence of a PVF after proctocolectomy for treatment of familial adenomatous polyposis in October 2005. Because local approaches failed, definitive closure of the fistula was achieved by interposition of a gracilis muscle flap between the pouch-anal anastomosis and the vagina. The postoperative course was uneventful; the patient was discharged 7 days after surgery and remained free of recurrence and symptomatic complaints for 22 months now. The gracilis muscle flap proved to be an effective method in the treatment of recurrent PVF.
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Ulrich D, Roos J, Jakse G, Pallua N. Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Reconstr Aesthet Surg 2009; 62:352-6. [PMID: 19158006 DOI: 10.1016/j.bjps.2008.11.067] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 11/04/2008] [Accepted: 11/09/2008] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several surgical procedures for the repair of fistulas between the rectum and the urethra or vagina have been reported. Our study was designed to assess the efficacy of the gracilis muscle flap in repairing recto-urethral and rectovaginal fistulas. METHODS Gracilis muscle interposition flaps were performed in 35 patients (aged 38-78 years, mean: 58 years) using a perineal approach. Nine patients had rectovaginal fistulas due to Crohn's disease (n=3), previous surgery and pelvic irradiation for rectal (n=2) or cervical cancer (n=4). Twenty-six fistulas were recto-urethral. The aetiologies were Crohn's disease (n=4), brachytherapy after prostate cancer (n=14), iatrogenic injury to the rectum during radical retropubic prostatectomy (n=4), transurethral resection of the prostate (n=2) and recurrent peri-anal abscesses with fistulas (n=2). Twenty-five patients had undergone previous repair attempts; of these four underwent multiple procedures. Patient outcomes were assessed after surgical repair. The success rate was measured as the percentage of patients with a healed fistula after stomal closure. RESULTS The mean follow-up was 28+/-15 months from muscle transposition and 22+/-14 months from stomal closure. Fistula closure with no recurrence could be achieved in 33 patients (94%). Two of the seven patients (29%) with Crohn's disease had a persistent fistula. There were neither intra-operative complications nor problems related to muscle desinsertion surgery. CONCLUSIONS Recto-urethral and rectovaginal fistula closure using the perineal approach with pedicled gracilis muscle interposition is associated with minimal morbidity and a high success rate. It is an excellent option for patients with complicated fistulas for whom other surgical treatments have failed. Underlying Crohn's disease is associated with a higher complication rate.
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Affiliation(s)
- Dietmar Ulrich
- Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital, Medical Faculty of the University of Technology, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248:39-43. [PMID: 18580205 DOI: 10.1097/sla.0b013e31817d077d] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to review our experience with gracilis muscle interposition for complex perineal fistulas. MATERIAL AND METHODS A retrospective review of all patients who underwent repair of perineal fistula using the gracilis muscle between 1995 and 2007 was undertaken. Patients were divided into 2 groups according to the fistula type by gender: females (rectovaginal and pouch-vaginal) and males (rectourethral). RESULTS Gracilis interposition was performed in 53 patients. Seventeen women underwent 19 gracilis interpositions for 15 rectovaginal and 2 pouch-vaginal fistulas; 76% had a mean of (1-4) (mean of 2) prior failed attempt at repair. Eight patients experienced at least one postoperative complication. Two women required a second gracilis interposition. Thirty-three percent of the Crohn's disease-associated fistulas successfully healed; 75% without Crohn's successfully healed.Thirty-six males underwent gracilis interposition for rectourethral fistulas, mainly due to prostate cancer treatment; 13 (36%) had a mean of 1.5 (range 1-3) failed prior repairs. Seventeen patients experienced postoperative complications. The initial success rate in men with rectourethral fistulas was 78%. After successful second procedures in 8 patients, the overall clinical healing rate was 97%. CONCLUSION The gracilis muscle transposition is a safe and effective method of treating complex perianal fistulas.
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