Surgical Strategy for Rectovaginal Fistula After Colorectal Anastomosis at a High-volume Cancer Center According to Image Type and Colonoscopy Findings.

Abstract

BACKGROUND/AIM:

The reported incidence of rectovaginal fistula is very low. Although some case reports have described surgical procedures, no systematic approach to the treatment of rectovaginal fistula according to diagnostic image and colonoscopy findings has been proposed. We present a comprehensive surgical strategy for rectovaginal fistula after colorectal anastomosis according to diagnostic image and colonoscopy findings.

PATIENTS AND METHODS:

This retrospective study included 11 patients who developed rectovaginal fistula after colorectal anastomosis. Rectovaginal fistula was classified into 4 types according to contrast enema images and colonoscopy findings, i.e., "Alone type", "Dead space type", "Anastomotic stricture type", and "Dead space and Anastomotic stricture type". The surgical strategies were "Diversion (Stoma)", "Percutaneous drainage", "Anastomotic stricture type", "Endoscopic balloon dilation", "Curettage of foreign bodies", "Simple full-thickness closure", "Split-thickness closure", "Pedicled flaps packing", and "Reanastomosis". The surgical strategy appropriate for each rectovaginal fistula type was investigated.

RESULTS:

Among "Alone type" cases, 5 (71.4%) healed with "only Diversion (Stoma)". "Alone type" cases (n=11) and all other cases (n=4) healed with "only Diversion (Stoma)" (n=5) or any other method (n=6) (p=0.022).

CONCLUSION:

For treatment of rectovaginal fistula after colorectal anastomosis, less invasive treatment approaches should be attempted first.

• Authors: Koji Komori, Takashi Kinoshita, Taihei Oshiro, Akira Ouchi, Seiji Ito, Tetsuya Abe, Yoshiki Senda, Kazunari Misawa, Yuichi Ito, Seiji Natsume, Eiji Higaki, Masataka Okuno, Takahiro Hosoi, Takuya Nagao, Aina Kunitomo, Satoshi Oki, Jin Takano, Yasuhito Suenaga, Shingo Maeda, Hideyuki Dei, Yoshihisa Numata, Yasuhiro Shimizu
• Journal: Anticancer research (Anticancer Res) Vol. 39 Issue 9 Pg. 5097-5103 (Sep 2019) ISSN: 1791-7530 [Electronic] Greece
• PMID: 31519621 (Publication Type: Journal Article)
• Copyright: Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Chemical References

• Contrast Media

Topics

• Anastomosis, Surgical
• Colonoscopy
• Colorectal Neoplasms (complications, diagnosis, surgery)
• Contrast Media
• Diagnostic Imaging
• Female
• Humans
• Male
• Rectovaginal Fistula (diagnosis, etiology, surgery)
• Retrospective Studies
• Treatment Outcome
• Tumor Burden