Afag AGHAYEVA, Deniz ATASOY, Erman AYTAÇ, Ebru KIRBIYIK, Semih BAĞHAKİ, Tayfun KARAHASANOĞLU, Bilgi BACA, İsmail HAMZAOĞLU

REKTOVAJINAL FISTÜL ONARIMI IÇIN MARTIUS FLEBI: OPERATIF TEKNIK VE POSTOPERATIF SONUÇLAR

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.

Martius Flap For Rectovaginal Fistula Repair: Operative Technique and Postoperative Outcomes

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:

Martius, advancement, flap, rectovaginal, fistula,

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