Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty
作者:
K. Khanduja,
A. Padmanabhan,
B. Kerner,
W. Wise,
P. Aguilar,
期刊:
Diseases of the Colon & Rectum
(OVID Available online 1999)
卷期:
Volume 42,
issue 11
页码: 1432-1437
ISSN:0012-3706
年代: 1999
出版商: OVID
关键词: Sphincteroplasty;Obstetrical injuries to rectum and vagina;Rectovaginal fistula
数据来源: OVID
摘要:
PURPOSE:This study evaluated the effectiveness of combining advancement flap with sphincteroplasty in patients symptomatic with rectovaginal fistula and anal sphincter disruption.METHODS:Twenty patients with rectovaginal fistulas and anal sphincter disruptions after vaginal deliveries underwent combined rectal mucosal advancement flap and anal sphincteroplasty between July 1986 and July 1993. The mean age of the patients was 30 (range, 18‐40) years and the mean duration of symptoms was 54.8 weeks (range, 7 weeks to 6 years). In addition to mucosal advancement flap repair, 13 patients underwent two‐layer repair of anal sphincters (with reapproximation of the puborectalis in 8 of the patients); 6 patients underwent one‐layer overlap repair of anal sphincters (with reapproximation of the puborectalis in 2 of the patients); and 1 patient underwent reapproximation of internal anal sphincter alone because squeeze pressures were adequate, as determined by anal manometry.RESULTS:Postoperatively, vaginal discharge of stool and flatus was eliminated entirely in all 20 patients. Perfect anal continence of stool and flatus was restored in 14 patients (70 percent). Incontinence was improved but not eliminated in six patients (4 incontinent to liquid stool and 2 to flatus), and two patients required perineal pads. Subjectively, 19 patients (95 percent) reported the result as excellent or good. There were no complications.CONCLUSION:The combination of mucosal advancement flap and anal sphincteroplasty is a safe and highly effective procedure for correcting rectovaginal fistula with sphincter disruption after obstetrical injuries.
点击下载:
PDF
(1779KB)
返 回