Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: a simple and effective technique.

INTRODUCTION: To report our experience with the anterior, transanal, transsphincteric, sagittal approach in the correction of rectourinary fistula secondary to laparoscopic radical prostatectomy. TECHNICAL CONSIDERATIONS: Of the first 110 laparoscopic extraperitoneal radical prostatectomies performed from December 2001 to February 2004, 9 (8%) were complicated by rectal injury. Of the nine rectal lesions, seven were diagnosed intraoperatively and the rectal defects closed laparoscopically. Primary repair failed in 1 of the 7 patients. In 2 other patients, the rectal injuries were missed intraoperatively, and a rectourinary fistula later developed. Rectourinary fistula was confirmed in these 3 patients by cystoscopy and digital rectal examination. The procedure chosen for repair was the anterior sagittal transrectal anal approach. The time from diagnosis to fistula repair was 1 to 3 months. Fistula repair was successful in all patients. The mean follow-up was 12 to 24 months. No patient presented with fecal incontinence or anal strictures. Postprostatectomy urinary continence was not affected by the procedure.
CONCLUSIONS: The transsphincteric transanal surgical approach provides many advantages for the repair of acquired urethrorectal fistulas after laparoscopic radical prostatectomy. It allows for good surgical exposure and fistula tract identification and ensures good access to well-vascularized tissue. This surgical technique is simple, effective, reproducible, and associated with minimal morbidity.