7/27/2019 Astrid Journal Endosurgery

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Evangelista, Eric V.

Endorectal advancement flap with muscular plication: a modified technique for rectovaginal fistula

repair.

By V. de Paredes, Z. Dahmani, P. Blanchard, J. D Zeitoun, S. Sultan and P. Atienza

I. IntroductionAcquired rectovaginal fistula is rare. It is due to various conditions, including obstetric injury,

inflammatory bowel disease, irradiation, neoplasia or accidental injury. Spontaneous healing is

rare, and treatment is usually necessary because of impairment of quality of life. Surgery is theonly effective treatment, but the choice of technique is controversial because there is no

uniformly successful treatment. The choice depends on the surgeon's expertise, the type of

fistula and the state of the anal sphincter. The aim was to improve the technique by usingadditional muscular procedure identifying factors that may predict success.

II. Research Design

the researchers used statistical analysis using STATA 9.0. Descriptive analysis reported

continuous data as means and categorical data as the number of observation and ratios orproportions.

III. Subjects

Inclusions Criteriaa. Patients with rectovaginal fistula who underwent this modified technique were reviewed.

Exclusion Criteria

b. Patients with Crohn's disease with proctitis, malignant or radiation related fistula, stricture ofthe anorectum or those with an external sphincter defect.

Sampling Method

c. Heterogenous sampling was utilized in the study.

IV. MethodologyPatients were included who had an acquired rectovatinal fistula. Exclusions included patients

with Crohn's disease with proctitis, malignant or radiation related fistula, stricture of the

anorectum or those with an external sphincter defect. Surgery included closure of the internalopening with a figure eight reabsorbable suture, plication of the anorectal muscular layer and

mucosal flap advancement. Total parenteral nutrition was administered post operatively for

seven days.V. Findings

The goal of the researchers was to create a second layer of well vascularized tissue,

incorporating a greater thickness of healthy tissue under the flap. The technique obtained a

success rate of 65%. Rectovaginal fistula is a surgical challenge because wound healing can beimpaired by a limited blood supply, the pressure in the distal rectum and anal canal scarring,

and inflamed tissue because of secondary infection, and or inflammatory disease. Moreover, the

success rate of 65% compares favorably with other published results of the endorectal flapprocedure. This procedure resulted with above average outcome show a great deal of promise

because it was easy to perform and was without significant complications. Thus, the technique

could be a valuable alternative for repair of rectovaginal fistula.