Abstract
Purpose: The most common reason for rectovaginal fistula RVF is obstetric trauma and the other most common cause is Crohn’s disease CD . Various surgical options, including sphincteroplasty, gracilis flaps, Martius flaps, fecal diversion and advancement flaps are discussed. The aim of this study is to present the techniques of Martius flap and present patients’ long-term surgical outcomes, quality of life and sexual activity.Methods: A total of six patients with RVF who underwent Martius flap procedure were included in this study. Patient demographics, perioperative outcomes, short and long-term results including quality of life QOL , sexual function and complications were evaluated. Results: Between April 2014 and August 2014 six female patients with RVF underwent Martius flap procedure. Mean age and body mass index were 47±14.17 and 25 , respectively. The indications for operation were Crohn’s disease n=3 , obstetrical trauma n=1 and postsurgical complications including stapler misfire n=1 and rectocele repair n=1 . The mean follow up was 32± 1.47 months. Cosmetic outcomes were good for all patients. As the result of the Female Sexual Function Index FSFI , 66% n=4 of patients have an active sexual life. QOL is well for all patients. The CGQL score was 0.8. Five patients are followed without recurrence but a patient with CD has recurrence at 18 mo. of operation.Conclusion: Considering the aforementioned advantages, the Martius flap is a feasible technique for RVF repair when performed selectively by experienced hands
Keywords
References
- Saclarides TJ. Rectovaginal fistula. Surg Clin North Am 2002;82:1261- 72. [CrossRef]
- Bangser M. Obstetric fistula and stigma. Lancet 2006; 367: 535–6. [CrossRef]
- Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG 2008;115:1564–9. [CrossRef]
- Champagne BJ, McGee MF. Rectovaginal fistula. Surg Clin North Am 2010; 90: 69–82. [CrossRef]
- Leroy A, Azais H, Giraudet G, et al. Quality of life and symptoms before and after surgical treatment of rectovaginal fistula. Prog Urol 2017; 27: 229-37. [CrossRef]
- Baig MK, Zhao RH, Yuen CH, et al. Simlpe rectovaginal fistulas. Colorectal Dis 2000; 15: 323-7. [CrossRef]
- Sonoda T, Hull T, Piedmonte MR, et al. Outcomes of primary repair of anorectal and rectovaginal fistula using the endorectal adcancement flap. Dis Colon Rectum 2002; 45: 1622-8. [CrossRef]
- Colon Rectum 2014; 57: 888–98. [CrossRef]
- Byrnes JN, Schmitt JJ, Faustich BM, et al. Outcomes of rectovaginal fistula repair. Female Pelvic Med Reconstr Surg 2017; 23: 124-30. [CrossRef]
- Pitel S, Lefevre JH, Parc Y, et al. Martius advancement flap for low rectovaginal fistula: short-and long-term results. Colorectal Dis 2011; 13: 112-115. [CrossRef]
- Sogne K, Scotte M, Lubrano J, et al. Treatment of anovaginal or rectovaginal fistulas with modified martius graft. Colorectal Disease 2007; 9: 653-6. [CrossRef]
- Nosti PA, Stahi TJ, Sokol AI. Surgical repair of rectovaginal fistulas in patients with Crohn’s disease. EurJ Obstet Gynecol Reprod Biol 2013;171: 166-70. [CrossRef]
- Tsang CB, Rothenberger DA. Rectovaginal fistulas. Therapeutic options. Surg Clin N Am 1997;77:95–114. [CrossRef]
- Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg 1997; 173: 95–8. [CrossRef]
- Lambertz A, Luken B, Ulmer TF, et al. Influence of diversion stoma on surgical outcome and recurrence rates in patients with rectovaginal fistula- A retrospective cohort study. Int J Surg 2016; 25: 114-7. [CrossRef]
- O’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl 1998; 80: 250-2.
- El-Gazzaz G, Hull TL, Mignanelli E, et al. Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function. J Gastrointest Surg 2010; 14:1757-63. [CrossRef]
- Zimmerman DD, Delamarre JB, Gosselink MP, et al. Smoking affects the outcome of transanal mucosal advancement flap repair of the trans-sphincteric fistulas. Br J Surg 2003; 90: 351-4. [CrossRef]
- Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol 2011; 11: 61. [CrossRef]
- McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg 2007; 193: 597-9. [CrossRef]
- Yañez R1, Oviedo A, Aldea M, Bueren JA, Lamana ML. Prostaglandin E2 plays a key role in the immunosuppressive properties of adipose and bone marrow tissue-derived mesenchymal stromal cells. Exp Cell Res 2010; 316: 3109-23. [CrossRef]
- Lo Sicco C, Reverberi D, Balbi C, et al. Mesenchymal Stem Cell- Derived Extracellular Vesicles as Mediators of Anti-Inflammatory Effects: Endorsement of Macrophage Polarization. Stem Cells Transl Med 2017; 6: 1018-1028. [CrossRef]
Abstract
Amaç: Rektovajinal fistülün RVF en sık nedeni obstetrik travmadır, diğer en sık görülen neden ise Crohn hastalığıdır CH . Bu konuda sfinkteroplasti, gracilis flepleri, Martius flepleri, fekal diversiyon ve ilerletme flepleri gibi çeşitli cerrahi seçenekler tartışılmaktadır. Bu çalışmanın amacı, Martius flep teknikğini ve mevcut hastaların uzun dönem cerrahi sonuçlarının, yaşam kalitesinin ve cinsel aktivite sonuçlarının sunulmasıdır. Yöntemler: Martius flep prosedürü uygulanan RVF’li altı hasta bu çalışmaya dahil edildi. Hasta demografisi, perioperatif sonuçlar, yaşam kalitesi QoL , cinsel fonksiyon ve komplikasyonları içeren kısa ve uzun dönem sonuçları değerlendirildi. Bulgular: Nisan 2014 ve Ağustos 2014 arasında RVF’li altı kadın hastaya Martius flep prosedürü uygulandı. Ortalama yaş ve vücut kitle indeksi sırasıyla 47 ± 14.17 dağılım, 33-68 ve 25 dağılım 20-36 idi. Operasyon endikasyonları Crohn hastalığı n = 3 , obstetrik travma n = 1 , stapler yalnış tetiklenmesi n = 1 ve rektosel onarımı n = 1 içeren cerrahi sonrası komplikasyon idi. Ortalama takip süresi 32 ± 1.47 3-34 ay idi. Kozmetik sonuçlar tüm hastalar için iyi idi. Kadın cinsel işlev indeksi FSFI sonucunda hastaların% 66’sı n = 4 aktif cinsel yaşantıya sahipti. QoL tüm hastalar için iyi idi. CGoL skoru 0.8 idi. Beş hasta nüks olmadan takip edilirken, CH’li bir hastada 18 ay sonra nüks saptandı. Sonuç: Yukarıda belirtilen avantajlar göz önüne alındığında, Martius flebi deneyimli ellerde uygulandığında RVF onarımı için uygun bir teknik olarak görülmektedir.
Keywords
References
- Saclarides TJ. Rectovaginal fistula. Surg Clin North Am 2002;82:1261- 72. [CrossRef]
- Bangser M. Obstetric fistula and stigma. Lancet 2006; 367: 535–6. [CrossRef]
- Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG 2008;115:1564–9. [CrossRef]
- Champagne BJ, McGee MF. Rectovaginal fistula. Surg Clin North Am 2010; 90: 69–82. [CrossRef]
- Leroy A, Azais H, Giraudet G, et al. Quality of life and symptoms before and after surgical treatment of rectovaginal fistula. Prog Urol 2017; 27: 229-37. [CrossRef]
- Baig MK, Zhao RH, Yuen CH, et al. Simlpe rectovaginal fistulas. Colorectal Dis 2000; 15: 323-7. [CrossRef]
- Sonoda T, Hull T, Piedmonte MR, et al. Outcomes of primary repair of anorectal and rectovaginal fistula using the endorectal adcancement flap. Dis Colon Rectum 2002; 45: 1622-8. [CrossRef]
- Colon Rectum 2014; 57: 888–98. [CrossRef]
- Byrnes JN, Schmitt JJ, Faustich BM, et al. Outcomes of rectovaginal fistula repair. Female Pelvic Med Reconstr Surg 2017; 23: 124-30. [CrossRef]
- Pitel S, Lefevre JH, Parc Y, et al. Martius advancement flap for low rectovaginal fistula: short-and long-term results. Colorectal Dis 2011; 13: 112-115. [CrossRef]
- Sogne K, Scotte M, Lubrano J, et al. Treatment of anovaginal or rectovaginal fistulas with modified martius graft. Colorectal Disease 2007; 9: 653-6. [CrossRef]
- Nosti PA, Stahi TJ, Sokol AI. Surgical repair of rectovaginal fistulas in patients with Crohn’s disease. EurJ Obstet Gynecol Reprod Biol 2013;171: 166-70. [CrossRef]
- Tsang CB, Rothenberger DA. Rectovaginal fistulas. Therapeutic options. Surg Clin N Am 1997;77:95–114. [CrossRef]
- Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg 1997; 173: 95–8. [CrossRef]
- Lambertz A, Luken B, Ulmer TF, et al. Influence of diversion stoma on surgical outcome and recurrence rates in patients with rectovaginal fistula- A retrospective cohort study. Int J Surg 2016; 25: 114-7. [CrossRef]
- O’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl 1998; 80: 250-2.
- El-Gazzaz G, Hull TL, Mignanelli E, et al. Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function. J Gastrointest Surg 2010; 14:1757-63. [CrossRef]
- Zimmerman DD, Delamarre JB, Gosselink MP, et al. Smoking affects the outcome of transanal mucosal advancement flap repair of the trans-sphincteric fistulas. Br J Surg 2003; 90: 351-4. [CrossRef]
- Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol 2011; 11: 61. [CrossRef]
- McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg 2007; 193: 597-9. [CrossRef]
- Yañez R1, Oviedo A, Aldea M, Bueren JA, Lamana ML. Prostaglandin E2 plays a key role in the immunosuppressive properties of adipose and bone marrow tissue-derived mesenchymal stromal cells. Exp Cell Res 2010; 316: 3109-23. [CrossRef]
- Lo Sicco C, Reverberi D, Balbi C, et al. Mesenchymal Stem Cell- Derived Extracellular Vesicles as Mediators of Anti-Inflammatory Effects: Endorsement of Macrophage Polarization. Stem Cells Transl Med 2017; 6: 1018-1028. [CrossRef]
Details
| Primary Language | English |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 1, 2020 |
| Published in Issue | Year 2020Issue: 3 |