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Rectovaginal Fistula (rectovaginal + fistula)
Selected AbstractsRectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinomaJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2006A. Klein An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential. [source] Long-term oral tacrolimus therapy in refractory to infliximab fistulizing Crohn's disease.INFLAMMATORY BOWEL DISEASES, Issue 1 2005A Pilot Study Abstract Aims: To evaluate efficacy and safety of oral tacrolimus in cases of fistulizing Crohn's disease (FCD), which is refractory to conventional therapy including infliximab. Methods: Patients with fistulas, previously and unsuccessfully treated with all conventional therapy (i.e., antibiotics, azathioprine, or 6-mercaptopurine and infliximab), were enrolled in a prospective, uncontrolled, open-label study of long-term treatment with oral tacrolimus (0.05 mg/kg every12 h). The evaluation of the clinical response was complemented by use of the perianal Crohn's disease activity index (PCDAI) and magnetic resonance imaging-based score (MRS) with determined periodicity. Results: Ten patients were included in the study (enterocutaneous fistula, 3 patients; perianal fistula, 4 patients; rectovaginal fistula, 3 patients) with 6 to 24 months of follow-up. Five patients were steroid-dependent, and 4 patients needed maintenance treatment with immunosuppressant agents. Four patients (40%) achieved complete clinical responses, which were verified by PCDAI and MRS. Five patients (50%) achieved partial responses (i.e., important decreases in fistula drainage, size, discomfort, and PCDAI/MRS values). Decreases in both the PCDAI and MRS were statistically significant (P < 0.05). All steroid-dependent patients stopped therapy with prednisone, and concomitant immunosuppressive therapy was tapered. The response was maintained, and no new flare-up of the disease was observed. Only mild adverse events were detected (1 patient withdrew from treatment due to headache), and no case of nephrotoxicity or diabetes was detected. One patient had received no benefit from therapy after 6 months. Conclusions: Oral tacrolimus could be an effective and safe treatment for patients with FCD, even if there has been no response to infliximab treatment. Randomized studies are needed to compare oral tacrolimus with infliximab in terms of efficacy, safety, and costs. [source] Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patientsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2008Fréderic Caquant Abstract Aim:, To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. Methods:, The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse ,3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. Results:, The mean age of patients was 63.5 years (30,94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/, elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Conclusion:, Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study. [source] Lower genital tract lesions requiring surgical intervention in girls: Perspective from a developing countryJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2009Sebastian O Ekenze Aim: To determine the spectrum, outcome of treatment and the challenges of managing surgical lesions of lower genital tract in girls in a low-resource setting. Method: Retrospective study of 87 girls aged 13-years and younger, with lower genital tract lesions managed between February 2002 and January 2007 at the University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Clinical charts were reviewed to determine the types, management, outcome of treatment and management difficulties. Results: The median age at presentation was 1 year (range 2 days,13 years). Congenital lesions comprised 67.8% and acquired lesions 32.2%. The lesions included: masculinised external genitalia (24), vestibular fistula from anorectal malformation (23), post-circumcision labial fusion (12), post-circumcision vulval cyst (6), low vaginal malformations (6), labial adhesion (5), cloacal malformation (3), bifid clitoris (3) urethral prolapse (3), and acquired rectovaginal fistula (2). Seventy-eight (89.7%) had operative treatment. Procedure related complications occurred in 19 cases (24.4%) and consisted of surgical wound infection (13 cases), labial adhesion (4 cases) and urinary retention (2 cases). There was no mortality. Overall, 14 (16.1%) abandoned treatment at one stage or another. Challenges encountered in management were inadequate diagnostic facilities, poor multidisciplinary collaboration and poor patient follow up. Conclusion: There is a wide spectrum of lower genital lesion among girls in our setting. Treatment of these lesions may be challenging, but the outcome in most cases is good. High incidence of post-circumcision complications and poor treatment compliance may require more efforts at public enlightenment. [source] Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinomaJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2006A. Klein An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential. [source] Treatment of rectovaginal fistula: A 5-year reviewAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2006Damian CASADESUS This paper presents a chart review of 17 patients who had been treated for rectovaginal fistula (RVF) from 1996 to 2000. In most cases (13; 76.5%), the fistula was the result of post-surgical complications. Following vaginal mucosa advancement flap repair or repair after conversion to a fourth-degree perineal laceration, 16 (94%) of the rectovaginal fistulae (during the first attempted repair or after failed treatment) were successfully treated. In all patients but one, faecal diversion was avoided. In two patients, fistulography was both a diagnostic procedure and the method of treatment. [source] Surgical correction of rectovaginal fistula in mares and subsequent fertilityAUSTRALIAN VETERINARY JOURNAL, Issue 6 2010SL Jalim Objective To evaluate the fertility of mares bred at various intervals relative to surgical management of rectovaginal fistula (RVF). Materials and Methods Surgical repair of RVF was performed in 28 mares at variable times relative to foaling (30 days to 24 months) and also relative to rebreeding (same cycle or delayed). Postoperative fertility was then evaluated. Results Two mares were already pregnant at the time of surgery and 20 of 23 mares (87%) that were bred immediately prior to or following surgery conceived from their first service. When mares were bred in the same cycle as surgery, the next cycle following surgery or in the following breeding season after surgery the pregnancy rate was 5/5, 5/6 and 10/12, respectively, and the foaling rates were 4/5, 4/6 and 7/12. The two mares already pregnant at the time of surgery foaled successfully. Conclusions Excellent fertility can be achieved following surgical repair of RVF and our results suggest that delaying breeding until the following breeding season is not necessary. In addition, breeding in the same cycle as the surgical repair is a previously unreported technique that should be considered to maintain normal fertility and a yearly foaling interval. [source] The impact of pre- or postoperative radiochemotherapy on complication following anterior resection with en bloc excision of female genitalia for T4 rectal cancerCOLORECTAL DISEASE, Issue 4 2009B. Szynglarewicz Abstract Objective, The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer. Method, The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6,8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA). Results, There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy. Conclusion, Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity. [source] Cloaca-like deformity with faecal incontinence after severe obstetric injury , technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplastyCOLORECTAL DISEASE, Issue 8 2008A. M. Kaiser Abstract Objective, Surgical technique and outcomes report. Summary background data, Three to eight per cent of vaginal deliveries are complicated by third- or fourth- degree perineal lacerations, resulting in a cloaca-like deformity in up to 0.3%. These three-dimensional defects result in often debilitating incontinence and symptoms similar to a rectovaginal fistula because of the lack of the distal rectovaginal septum. Method, Between 2001 and 2006, 12 women (median age 37, range 20,57) with faecal incontinence and a postobstetric-injury-associated cloaca-like deformity underwent an ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty without primary faecal diversion. Results, The patients presented 13.0 ± 2.9 years (range 0.5,29 years) after the obstetric injury. The median Cleveland Clinic Florida faecal incontinence score was 16 (range 12,19). In addition, one patient complained of vaginal discharge, another of dyspareunia. All patients had an open rectovaginal communication with a large anterior sphincter defects (mean 160.2 ± 22.8 degrees, range 113,180). Resting/squeeze pressures were 28.0 ± 4.4/63.2 ± 8.1 mmHg, respectively. Pudendal neuropathy was present in five patients. The median length of hospital stay after surgery was 5.3 ± 0.7 days. Three patients experienced a postoperative rectovaginal fistula, two of which closed spontaneously, whereas the third required faecal diversion and a bulbocavernosus flap. After surgical follow-up of 9.8.3 ± 2.8 months and long-term follow-up of 38.9.0 ± 6.9 months, all the patients were satisfied with regards to overall function, continence and cosmetic result. Conclusion, Cloaca-like deformity resulting from severe obstetric injury is often not given appropriate attention. Reconstruction of the original anatomy is complex but achieves good results and does not require a prophylactic faecal diversion. [source] TEMS: an alternative method for the repair of benign recto-vaginal fistulaeCOLORECTAL DISEASE, Issue 6 2008R. J. Darwood Abstract Indications, The repair of high recto-vaginal fistula can be challenging since access may be limited via the endo-anal approach yet the alternative trans-abdominal route carries significant morbidity. We report the use of TEMS to repair a recto-vaginal fistula following anterior resection and pelvic radiotherapy. Method, The patient was placed prone and a 25cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. Comparison with other techniques, TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo-anal or trans-vaginal techniques. The morbidity is lower than the trans-abdominal route. Comments, TEMS is a useful technique for the repair of benign recto-vaginal fistula and has distinct advantages over conventional techniques. [source] | ||||||||||