Surgical treatment results for high rectovaginal fistulas using invagination technique


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Abstract

Background. Rectovaginal fistula (RVF) is a rare type of malformation. Rectovaginal fistulas represent 5% of all anorectal fistulas. The results of surgical treatment are disappointing, and disease recurrence is in 20-80% of cases. Aim. Assessment of the efficacy of invagination technique. Materials and methods. The study included 57 women with high RVFs aged 20-73 years. The mean age of the patients was 34years. The causes of RVFs were: inflammatory diseases in 11 women (19,3%); obstetric injury - in 29 (51%); pelvic surgery - in 12 (21%); and RVFs due to other causes - in 5 (8,8%) women. 33 (57,8%) patients previously underwent surgical tratment. Diverting stomas were previously formed in 11 cases (19,2%). Results. Surgical treatment using invagination technique was performed in all patients. The mean follow-up period was 23,2 months. Successful treatment of patients was in 63.2% of cases, and no postoperative complications were registered. Conclusion. The invagination technique is an effective and safe method for treatment of high rectovaginal fistulas. In most cases application of this technique is possible without performing preventive colostomy.

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About the authors

A. A Mudrov

Ryzhikh National Medical Research Center of Coloproctology; Researcher of the Department of Coloproctology, Russian Medical Academy of Postgraduate Education

Ph.D., Researcher at the Department of General and Reconstructive Coloproctology, Ryzhikh National Medical Research Center of Coloproctology; Researcher of the Department of Coloproctology, Russian Medical Academy of Postgraduate Education 123423, Russia, Moscow, Salyama Adilya str., 2

V. I Krasnopolsky

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gynendoscopy@mail.ru
M.D., Ph.D., Professor, Academician of RAS, Presiden 101000, Russia, Moscow, Pokrovka str., 22а

A. A Popov

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gynendoscopy@mail.ru
M.D., Ph.D., Professor, Head of the Endoscopic Surgery 101000, Russia, Moscow, Pokrovka str., 22а

A. Yu Titov

Ryzhikh National Medical Research Center of Coloproctology

Email: info@gnck.ru
M.D., Ph.D., Head of the Department of General and Reconstructive Coloproctology 123423, Russia, Moscow, Salyama Adilya str., 2

O. Yu Fomenko

Ryzhikh National Medical Research Center of Coloproctology

Email: oksana671@yandex.ru
M.D., Ph.D., Head of the Laboratory of clinical pathophysiology 123423, Russia, Moscow, Salyama Adilya str., 2

L. A Blagodarny

Russian Medical Academy of Postgraduate Education

Email: rmapo@rmapo.ru
M.D., Ph.D., Professor 1488. 123242, Russia, Moscow, Barrikadnaya str., 2/1

I. V Kostarev

Ryzhikh National Medical Research Center of Coloproctology; Researcher of the Department of Coloproctology, Russian Medical Academy of Postgraduate Education

Email: info@gnck.ru
M.D., Ph.D., Head of the Department of Minimally Invasive Coloproctology and Pelvic Surgery, Ryzhikh National Medical Research Center of Coloproctology; Researcher of the Department of Coloproctology, Russian Medical Academy of Postgraduate Education 123423, Russia, Moscow, Salyama Adilya str., 2

Yu. A Sokolova

Ryzhikh National Medical Research Center of Coloproctology

Email: info@gnck.ru
doctor doctor, Ryzhikh National Medical Research Center of Coloproctology

M. M Omarova

Russian Medical Academy of Postgraduate Education

Email: rmapo@rmapo.ru
postgraduate student of the Department of Coloproctology 123242, Russia, Moscow, Barrikadnaya str., 2/1

Yu. A Shelygin

Ryzhikh National Medical Research Center of Coloproctology; Russian Medical Academy of Postgraduate Education

M.D., Ph.D., Professor, Academician of RAS, Ryzhikh National Medical Research Center of Coloproctology; Head of the Department of Coloproctology, Russian Medical Academy of Postgraduate Education 123423, Russia, Moscow, Salyama Adilya str., 2

References

  1. Vogel J.D., Johnson E.K., Morris A.M., Paquette I.M., Saclarides T.J., Feingold D.L., Steele S.R. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis. Colon Rectum. 2016; 59(12): 1117-33. https://dx.doi.org/10.1097/DCR.0000000000000733.
  2. Abu-Gazala M, Wexner S.D. Management of rectovaginal fistulas and patient outcome. Expert Rev. Gastroenterol. Hepatol. 2017; 11(5): 461-71. https:// dx.doi.org/10.1080/17474124.2017.1296355.
  3. Byamugisha J, El Ayadi A., Obore S., Mwanje H., Kakaire O., Barageine J. et al. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol. Reprod. Health. 2015; 18(12): 115. https:// dx.doi.org/10.1186/s12978-015-0100-1.
  4. Gottgens K, Smeets R, Stassen L., Beets G., Breukink S.O. 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(7): 888-98. https://dx.doi.org/10.1097/DCR.0000000000000147.
  5. Trompetto M., Luc R.A., Novelli E., Tutino R., Clerico G., Gallo G. Use of the Martius advancement flap for low rectovaginal fistulas. Colorectal Dis. 2019; 21(12): 1421-8. https://dx.doi.org/10.1111/codi.14748.
  6. Шелыгин Ю.А., ред. Клинические рекомендации. Колопроктология. М.: ГЭОТАР-Медиа; 2015: 108-25.
  7. Koenig F. Ueber Einstulpungsmethode bei der Operation der Fistula colli congenita und die gelegentliche Auwendung bei einer Mastdarmfistel. Arch. Klin. Chir. 1905; 70: 1008.
  8. Futh H. Zur Operation der Blasen-scheidenfistel. Arch. Gynak. 1918; 109: 488-9.
  9. Аминев А.М. Руководство по проктологии. Куйбышев: «Волжская Коммуна»; 1973; 3: 368-87.
  10. Агаев Б.А., Джавадов Э.А., Аббасова Г.А. Хирургическое лечение средних и нижних ректовагинальных свищей методом инвертации. Хирургия. Журнал им. Н.И. Пирогова. 2010; 2: 44-6
  11. Мудров А.А., Шелыгин Ю.А., Титов А.Ю., Фоменко О.Ю., Благодарный Л.А., Соколова Ю.А., Костарев И.В., Омарова М.М. Малоинвазивный подход при лечении ректовагинальных свищей высокого уровня (первый опыт применения «инвагинационного» метода). Колопроктология. 2018; 4: 39-44
  12. Шелыгин Ю.А., Фоменко О.Ю., Титов А.Ю., Берсенева Е.А., Мудров А.А., Белоусова С.В. Сфинктерометрическая градация недостаточности анального сфинктера. Колопроктология. 2016; 4: 54-9

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