Hiroyuki Ohta1,2, Kyozo Hashimoto3, Tomoyuki Mizukuro4, Byonggu An5, Yumi Zen5, Yusuke Nishina5, Yoshitaka Terada5, Naomi Kitamura6,5, Hiroya Akabori6,5, Mitsuhiro Fujino4, Eiji Mekata6,5. 1. Department of Comprehensive Surgery, Shiga University of Medical Science, Seta-tsukinowa cho, Otsu, Shiga, 520-2192, Japan. hohta@belle.shiga-med.ac.jp. 2. Department of Surgery, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashioumi, Shiga, 527-8505, Japan. hohta@belle.shiga-med.ac.jp. 3. Hashimoto Clinic, 2-9-12 Kaiden, Nagaokakyo, Kyoto, 617-0826, Japan. 4. Nagaokakyo Hospital, 4-9-10 Kaiden, Nagaokakyo, Kyoto, 617-0826, Japan. 5. Department of Surgery, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashioumi, Shiga, 527-8505, Japan. 6. Department of Comprehensive Surgery, Shiga University of Medical Science, Seta-tsukinowa cho, Otsu, Shiga, 520-2192, Japan.
Abstract
BACKGROUND: Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown a satisfactory outcome. We present two consecutive Japanese patients who underwent successful surgery for an RVF after low anterior resection. CASE PRESENTATION: The patients were two women (61-year-old and a 64-year-old). They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected at just oral side to the RVF. Thereafter, in combination with a perineal approach, the rectum, along with a previous anastomosis and fistula, were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both patients, the postoperative courses were uneventful. They complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months after diverting stoma closure. CONCLUSIONS: A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for RVF after low anterior resection for rectal cancer.
BACKGROUND:Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown a satisfactory outcome. We present two consecutive Japanese patients who underwent successful surgery for an RVF after low anterior resection. CASE PRESENTATION: The patients were two women (61-year-old and a 64-year-old). They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected at just oral side to the RVF. Thereafter, in combination with a perineal approach, the rectum, along with a previous anastomosis and fistula, were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both patients, the postoperative courses were uneventful. They complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months after diverting stoma closure. CONCLUSIONS: A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for RVF after low anterior resection for rectal cancer.
Authors: Rodrigo A Pinto; Thais V Peterson; Sherief Shawki; G Willy Davila; Steven D Wexner Journal: Dis Colon Rectum Date: 2010-09 Impact factor: 4.585