Research Article
Year 2019,
Volume: 2 Issue: 2, 97 - 106, 31.08.2019
Abstract
Giriş: Rektovajinal fistül
(RVF) rektum ön duvarı ile vajen arka duvarı arasında anormal epitelyal
bağlantı olmasıdır. Etyolojide cerrahi travma, doğum, inflamatuar barsak
hastalığı ve kanser vardır. Bu çalışmada kliniğimizde rektovajinal fistül
nedeniyle tedavi edilen 14 hastanın özelliklerini, uygulanan cerrahi yöntem ve
sonuçlarını bildirmeyi amaçladık.
Gereç ve Yöntemler:Çalışmamızda Ocak 2002
ve Aralık 2018 tarihleri arasında RVF nedeniyle ameliyat edilen 14 hastanın
klinik ve demografik özellikleri geriye dönük olarak incelendi.
Sonuç: Hastaların ortalama
yaşı 47 (24-79) idi. Hastalarının tamamının başvuru şikayeti vajenden gaz ve
gayta gelmesiydi. On hastanın fizik
muayenesinde belirgin fistülü varken dört hastaya tanı kontrastlı kolon grafisi
ile konuldu. On (%71,4) hastaya transperineal yaklaşımla mukozal flep
uygulanırken; 4 (% 28,6) hastaya
kolostomi açılması+ mukozal flep uygulandı. Beş( % 35,7) hastada kanser (serviks ve
rektum kanseri), 4(% 28,6) hastada cerrahi travma, 2( %14,3) hastada doğum, 1(
%7,1) hastada inflamatuar barsak
hastalığı etyolojik nedendi. Hastanede
yatış süresi ortalama 4,8 (1-15 ) gün idi. Ortalama takip süresi 22 (3- 140) ay
olup 9 (% 64,3) hastada nüks görüldü.
Nüks olan 5 hastaya tekrar mukozal flep uygulanarak başarı sağlandı.
Nüks olan 2 hastaya fistül embolizasyonu yapılarak başarı sağlandı.
Tartışma: RVF cerrahisinde
başarıyı etkileyen önemli faktörlerden birisi etyolojidir. Kansere bağlı
gelişen rektovajinal fistüllerde tedavi oldukça zordur.
Supporting Institution
Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu tarafından onaylanmış (Proje no: KA19/124) ve Başkent Üniversitesi Araştırma Fonunca desteklenmiştir.
Project Number
KA19/124
References
- Kaynaklar:1. Tanag MA, Kubo T, Yano K, Inoue Y, Hosokawa K. Simple repair of complex rectovaginal fistulas. Scand J Plast Reconstr Surg Hand Surg. 2004; 38: 121-124.
- 2. Leroy A, Azaïs H, Giraudet G, Cosson M. Quality of life and symptoms before and after surgical treatment of rectovaginal fistula. Prog Urol. 2017 Mar;27(4):229-237. doi: 10.1016/j.purol.2016.12.001. Epub 2017 Jan 3.
- 3. Soriano D, Lemoine A, Laplace C, Deval B, Dessolle L, Darai E, Poitout P. Results of recto- vaginal fistula repair: retrospective analysis of 48 cases. Eur J Obstet Gynecol Rep Biol. 2001; 96: 75-79.
- 4. Bai SW, Kim SH, Kwon HS, Rha KH, Chung KA, Kim SK. Surgical outcome of female genital fistula in Korea. Yonsei Med. J 2002; 43: 315-319.
- 5.Dunn KB, Rothenberger DA. Rectovaginal fistula, ed: Brunicardi FC. In: Schwartz’s Principles of Surgery. 10th edition. 2016.
- 6. Das B, Snyder M. Rectovaginal fistulae. Clin Colon Rectal Surg. 2016;29:50–6.
- 7. Lowry AC, Thorson AG, Rothenberger DA, Goldberg SM. Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum. 1988;31:676–678.
- 8. Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum. 1995;38:4–6.
- 9. H ull TL, El-Gazzaz G, Gurland B, Church J, Zutshi M. Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin. Dis Colon Rectum. 2011;54:54–59.
- 10. T sang CB, Madoff RD, Wong WD, et al. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum. 1998;41:1141–1146.
- 11. Abcarian H, Chaudry V. Gastrointestinal fistulas. In: Billingham RP et al. Reoperative pelvic surgery. Springer, Heidelberg. 2009, pp 185-189.
- 12. Aguirre-Mar D, Serrano BA, Morales C, Toro K, Burgos J. Long-term success of complex recurrent rectovaginal fistula repair. J Surg Case Rep. 2019 Mar 12;2019(3):rjz001. doi: 10.1093/jscr/rjz001.
- 13. Troja A, Käse P, El-Sourani N, Raab H, Antolovic D. Treatment of recurrent rectovaginal/pouch-vaginal fistulas by gracilis muscle transposition—a single center experience. J Visc Surg. 2013;150:379–82.
- 14. Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2016 Dec;59(12):1117-1133.
- 15. Park SO, Hong KY, Park KJ, Chang H, Shin JY, Jeong SY. Treatment of rectovaginal fistula with gracilis muscle flap transposition: long-term follow-up. Int J Colorectal Dis. 2017 Jul;32(7):1029-1032. doi: 10.1007/s00384-017-2784-x. Epub 2017 Feb 16. PMID: 28210852.
- 16. Gordon PH, Nivatvongs S. Principles and Practice of Surgery for the Colon, Rectum, and Anus. 2nd ed. St. Louis, MO: Quality Medical Publishing; 1999.
- 17. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45:1622–1628.
- 18. Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD. Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum. 2010;53:1240–1247.
- 19. O ’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl. 1998;80:250–252.
Year 2019,
Volume: 2 Issue: 2, 97 - 106, 31.08.2019
Abstract
Project Number
KA19/124
References
- Kaynaklar:1. Tanag MA, Kubo T, Yano K, Inoue Y, Hosokawa K. Simple repair of complex rectovaginal fistulas. Scand J Plast Reconstr Surg Hand Surg. 2004; 38: 121-124.
- 2. Leroy A, Azaïs H, Giraudet G, Cosson M. Quality of life and symptoms before and after surgical treatment of rectovaginal fistula. Prog Urol. 2017 Mar;27(4):229-237. doi: 10.1016/j.purol.2016.12.001. Epub 2017 Jan 3.
- 3. Soriano D, Lemoine A, Laplace C, Deval B, Dessolle L, Darai E, Poitout P. Results of recto- vaginal fistula repair: retrospective analysis of 48 cases. Eur J Obstet Gynecol Rep Biol. 2001; 96: 75-79.
- 4. Bai SW, Kim SH, Kwon HS, Rha KH, Chung KA, Kim SK. Surgical outcome of female genital fistula in Korea. Yonsei Med. J 2002; 43: 315-319.
- 5.Dunn KB, Rothenberger DA. Rectovaginal fistula, ed: Brunicardi FC. In: Schwartz’s Principles of Surgery. 10th edition. 2016.
- 6. Das B, Snyder M. Rectovaginal fistulae. Clin Colon Rectal Surg. 2016;29:50–6.
- 7. Lowry AC, Thorson AG, Rothenberger DA, Goldberg SM. Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum. 1988;31:676–678.
- 8. Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum. 1995;38:4–6.
- 9. H ull TL, El-Gazzaz G, Gurland B, Church J, Zutshi M. Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin. Dis Colon Rectum. 2011;54:54–59.
- 10. T sang CB, Madoff RD, Wong WD, et al. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum. 1998;41:1141–1146.
- 11. Abcarian H, Chaudry V. Gastrointestinal fistulas. In: Billingham RP et al. Reoperative pelvic surgery. Springer, Heidelberg. 2009, pp 185-189.
- 12. Aguirre-Mar D, Serrano BA, Morales C, Toro K, Burgos J. Long-term success of complex recurrent rectovaginal fistula repair. J Surg Case Rep. 2019 Mar 12;2019(3):rjz001. doi: 10.1093/jscr/rjz001.
- 13. Troja A, Käse P, El-Sourani N, Raab H, Antolovic D. Treatment of recurrent rectovaginal/pouch-vaginal fistulas by gracilis muscle transposition—a single center experience. J Visc Surg. 2013;150:379–82.
- 14. Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2016 Dec;59(12):1117-1133.
- 15. Park SO, Hong KY, Park KJ, Chang H, Shin JY, Jeong SY. Treatment of rectovaginal fistula with gracilis muscle flap transposition: long-term follow-up. Int J Colorectal Dis. 2017 Jul;32(7):1029-1032. doi: 10.1007/s00384-017-2784-x. Epub 2017 Feb 16. PMID: 28210852.
- 16. Gordon PH, Nivatvongs S. Principles and Practice of Surgery for the Colon, Rectum, and Anus. 2nd ed. St. Louis, MO: Quality Medical Publishing; 1999.
- 17. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45:1622–1628.
- 18. Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD. Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum. 2010;53:1240–1247.
- 19. O ’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl. 1998;80:250–252.
There are 19 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Surgery |
| Journal Section | Articles |
| Authors | |
| Project Number | KA19/124 |
| Publication Date | August 31, 2019 |
| Acceptance Date | July 25, 2019 |
| Published in Issue | Year 2019 Volume: 2 Issue: 2 |
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