Uğur TOPAL, Ahmet RENCUZOĞULLARI, İsmail Cem ERAY, Ömer ALABAZ

Management of rectovaginal fistulas secondary to use of stapling device for rectal cancer surgery

Aim: Scarce data are available for rectovaginal fistula (RVF) as a serious complication of low anterior resection with a double-stapledanastomosis for rectal cancer. In this study, we aimed to evaluate our surgical management of RVFs formed due to stapler use.Material and Methods: Between 2010 and 2018, patients who developed rectovaginal fistula after the use of circular stapler duringrectal surgery were included. Clinic characteristics, type of surgical treatment performed and details of surgery in patients wereretrospectively evaluated.Results: Ten patients for whom stapler device was used for rectal cancer surgery and diagnosed with RVF were included in ourstudy. The mean age of the patients was 45.7±11.8 and mean BMI value was 27±2.4. For 9 patients who had primary repair forRVFs, 7 patients experienced recurrence after their first operation. For this subgroup, muscle flap was performed in 3, vaginalmucosa advancement flap 2, sartius flap one, and another primary repair plus fibrin glue application one patient. After the secondinterventions, two patients were managed with muscle flap creation and primary repair plus fibrin glue was required for one patient,for their recurrence. For patient who had primary repair plus fibrin glue application for her second operation, sigmoid colostomyfollowed by abdominoperineal resection was required for persisting complaints.Conclusion: The management of postoperative (RVF) after low anterior resection for rectal cancer is difficult and the results are oftenunsatisfactory. Endoanal mucosal flaps and muscle flaps are the treatment modalities we recommend, especially in patients withrecurrence.

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