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Background: Postoperative rectovaginal fistula leads to a loss of patients' quality of life and presents significant challenges to the surgeon. The literature focusing specifically on postoperative rectovaginal fistulas is limited. The objective of the present study is to identify factors that can enhance the success of the management of this postoperative rectovaginal fistula. Methods: This retrospective multicentric study included all patients undergoing surgery for rectovaginal fistulas, excluding those for whom the etiology of rectovaginal fistula was not postoperative. The major outcome measure was the success of the procedure. Results: A total of 82 patients with postsurgical fistulas were identified, of whom 70 were successfully treated, giving a success rate of 85.4%. On average, these patients required 3.04 ± 2.72 interventions. The creation of a diversion stoma did not increase the success rate of management [odds ratio (OR) = 0.488; 95% confidence interval (CI) 0.107–2.220]. Among the 217 procedures performed, 69 were successful, accounting for a 31.8% success rate. The number of interventions and the creation of a diversion stoma did not correlate with the success of management. However, direct coloanal anastomosis was significantly associated with success (OR = 35.06; 95% CI 1.271–997.603; p = 0.036) as compared with endorectal advancement flap (ERAF). Other procedures such as Martius flap did not show a significantly higher success rate. Conclusion: The creation of a diversion stoma is not necessary in closing a fistula. ERAF should be considered as a first-line treatment prior to proposing more invasive approach such as direct coloanal anastomosis. [ABSTRACT FROM AUTHOR]

Background: Rectovaginal fistulas (RVFs) present a significant surgical challenge, particularly those resulting from gynecologic procedures, which are often complex and associated with higher recurrence rates. The Martius Flap technique, which involves the use of a vascularized adipose tissue graft, is an established method for enhancing fistula repair, especially in cases involving large, recurrent, or radiation-induced fistulas. Materials and Methods: We conducted a prospective evaluation of 46 female patients with RVFs treated using the Martius Flap technique between December 2008 and December 2019. The study focused on patients with RVFs caused predominantly by gynecologic procedures, including surgeries for benign and malignant conditions, as well as those with a history of radiation therapy. Results: The average age of the patients was 38.7 years (range 18– 75 years). Of the 46 RVFs treated, 65.2% were due to gynecologic surgery, 26.1% were associated with iatrogenic injury or radiation therapy, and 8.7% were post-coital. Successful fistula closure was achieved in 95.6% of cases, with a recurrence rate of 4.4%. The Martius Flap demonstrated high efficacy, particularly in large and complex fistulas, with most patients reporting significant satisfaction and improved continence post-operatively. Conclusion: The Martius Flap technique is a highly effective option for the surgical management of RVFs, particularly those secondary to gynecologic procedures. The technique's ability to introduce well-vascularized tissue into the repair site significantly reduces recurrence rates and enhances healing, making it a preferred method for treating complex and recurrent RVFs. [ABSTRACT FROM AUTHOR]

Background: Ileal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180–360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure. Methods: Patients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%). Results: Over a 12-year period, nine patients were identified; the median age at CPA was 41 (36–44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1–2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn's disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6–24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up. Conclusions: Transanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition. Methods: We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011–2023). Information about HIV management, surgical history, and long-term outcomes was collected. Results: Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1–3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5–55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3–25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05). Conclusion: While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes. [ABSTRACT FROM AUTHOR]

Background: Fourth-degree perineal tears associated with vaginal delivery (PTAVD) occur in approximately 0.25 to 6% of vaginal deliveries. A persistent challenge in treating fourth-degree PTAVD is the high incidence of anastomotic leakage, leading to impaired quality of life, marked by incontinence, rectovaginal fistula, and painful sexual intercourse. Thus, effective interventions are necessary. Herein, we report our successful approach in repairing a fourth-degree PTAVD, involving the placement of a transanal decompression tube (TDT) during the early postoperative period. Case presentation: Five patients underwent the repair of fourth-degree PTAVD by suturing the mucosal and muscular layers of the rectum, and the vaginal wall in layers. Subsequently, a TDT was placed in the rectum, positioned 10–15 cm from the anal verge. The TDT was allowed to drain spontaneously without suction. Gastrografin enema examination was performed through a TDT, followed by a computed tomographic scan on postoperative days 3–4. After unfavorable complications were ruled out, the TDT was removed and the patients were transitioned to a normal diet. Result: All patients showed favorable outcomes with no occurrence of vaginal fistula or incontinence. Conclusion: This simple intervention demonstrates potential efficacy in reducing anastomotic leakage following the repair of fourth-degree PTAVD. [ABSTRACT FROM AUTHOR]

Abstract Various surgical methods have so far been developed for treating rectovaginal fistula (RVF), each with its own advantages and disadvantages. The lack of standardized animal models of RVF is a major reason for the failure to establish a unified and effective surgical method for the treatment of RVF. This study aimed to explore the feasibility of an RVF animal model by magnetic compression and compare it with the traditional modeling method. Thirty-two female Japanese white rabbits were randomly divided into four groups: A, B, C, and D, based on how the rectovaginal septum was treated. The operation time, intraoperative blood loss, and model success rate of each group were determined. The experimental animals were euthanized 2 weeks after the operation. Their rectovaginal septum specimens were obtained. RVF was observed by the naked eye. The fistula size was measured. Histological changes of fistula were observed by hematoxylin and eosin and Masson staining. All rabbits completed the RVF model and survived 2 weeks after the operation. Groups A and B had no bleeding, while groups C and D had

Sota Katsube,1 Satohiro Matsumoto,1 Masahiro Misawa,2 Nao Kakizawa,3 Ryo Hashimoto,1 Taku Mizutani,1 Keita Matsumoto,1 Shuhei Yoshikawa,1 Hirosato Mashima1 1Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan; 2Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, Saitama, Japan; 3Department of General and Gastrointestinal Surgery, Jichi Medical University Saitama Medical Center, Saitama, JapanCorrespondence: Sota Katsube, Department of Gastroenterology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Saitama, Omiya, 330-8503, Japan, Tel +81 48 647 2111, Fax +81 48 648 5188, Email m08029sk@jichi.ac.jpAbstract: The patient was a 50-year-old Japanese woman who was diagnosed with total-colitis-type ulcerative colitis (UC) at the age of 26 years. She was treated with mesalazine and azathioprine, and her disease activity was well controlled. At the age of 50 years, the patient was experiencing fever, abdominal pain, diarrhea, bloody stool, and anal pain, which led to a diagnosis of a relapse of UC. Although steroid therapy was administered and tended to improve her symptoms, fecaloid vaginal discharge occurred, and rectovaginal fistula (RVF) was confirmed. Colostomy was performed, and infliximab was initiated as maintenance therapy for UC. All symptoms improved, and RVF closure was confirmed 6 months after the initiation of infliximab. To date, she has been free from relapse of UC. There have been only a few reports of UC complicated by RVF, and this condition is often difficult to treat. To the best of our knowledge, no other case of UC complicated by RVF in which the fistula was closed after treatment with colostomy and infliximab has been previously reported; thus, our report of the present case is valuable to the literature.Keywords: ulcerative colitis, rectovaginal fistula, infliximab, colostomy

Background: As an innovative treatment, stapled transperineal rectovaginal fistula repair (STR) for rectovaginal fistula (RVF) has demonstrated effectiveness in preliminary reports. This study aims to compare STR with rectal mucosal advancement flap repair (RAF), a widely utilized surgical procedure, for the surgical outcome of the low- and mid-level RVF. Methods: In this retrospective cohort study, patients with low- and mid-level RVF who underwent STR or RAF were included from both the Sixth Affiliated Hospital of Sun Yat-sen University and Xi'an Daxing Hospital. Among the 99 total patients, 77 underwent STR and 22 underwent RAF. Patient demographics, operative data, and outcomes were collected and analyzed. Recurrence rate and associated risk factors were evaluated. Results: There were no statistically significant differences among patients in terms of clinical characteristics like age, BMI, aetiology, and fistula features. During the follow-up period of 20 months (interquartile range 3.0–41.8 months), a total of 28 patients relapsed, with a significantly lower recurrence rate in the STR group (20.8 %) than in the RAF group (54.6 %) (P = 0.005). In the multivariate Cox analysis, STR was an independent protective factor against recurrence (HR: 0.37, 95%CI: 0.17–0.79, P = 0.01). Logistic regression indicated that there was no statistically significant difference between these two procedures in terms of surgical complications (OR: 0.53, 95%CI: 0.19–1.48, P = 0.23). Conclusion: For low- and mid-level RVF, STR may be an alternative option for treatment modality that offers a lower recurrence rate, without observed disadvantage in terms of surgical complication rates.

Reconstruction of complex rectovaginal fistula is challenging, and it has a high recurrence rate. Traditional reconstruction included a local flap or a myocutaneous flap reconstruction, which is either difficult in radiated cases or that the flap is too thick for flap inset and requires multiple times of revision. Here we report successful rectovaginal fistula repair using a pedicled medial circumflex femoral artery perforator flap (MCFAP).A retrospective chart review was done to collect the information of this 63-year-old female patient who had rectovaginal fistula (RVF) resulting from concurrent radiochemotherapy for cervical cancer. She received direct repair of the RVF, but it recurred. We applied a pedicle perforator flap to successfully repair the defect.The fistula was repaired by separating the posterior vaginal wall from the anterior rectal wall. The anterior wall of the rectum was primarily repaired, leaving a defect of 4 × 5 cm in the posterior vaginal wall. A pedicled MCFAP flap was harvested from her right medial thigh and transferred via a subcutaneous tunnel for reconstruction of the posterior vaginal wall defect. The postoperative course was uneventful. Postoperative gastrointestinal series showed no more RVF, and her colostomy was taken down one year after the reconstruction.This first experience suggests that a pedicle perforator flap can be used successfully for reconstruction of a rectovaginal fistula.

Various surgical methods have so far been developed for treating rectovaginal fistula (RVF), each with its own advantages and disadvantages. The lack of standardized animal models of RVF is a major reason for the failure to establish a unified and effective surgical method for the treatment of RVF. This study aimed to explore the feasibility of an RVF animal model by magnetic compression and compare it with the traditional modeling method. Thirty-two female Japanese white rabbits were randomly divided into four groups: A, B, C, and D, based on how the rectovaginal septum was treated. The operation time, intraoperative blood loss, and model success rate of each group were determined. The experimental animals were euthanized 2 weeks after the operation. Their rectovaginal septum specimens were obtained. RVF was observed by the naked eye. The fistula size was measured. Histological changes of fistula were observed by hematoxylin and eosin and Masson staining. All rabbits completed the RVF model and survived 2 weeks after the operation. Groups A and B had no bleeding, while groups C and D had < 0.5 mL of bleeding. The magnet detached in 4–6 days in group A, while it remained in place for 2 weeks after surgery in group B. Only one group D rabbit had a plastic hose for 2 weeks after surgery. The RVFs of groups A and C healed by themselves. In group B, the fistula was well formed. In group D, fistula healing was observed in three animals and the diameter of the fistulas was only 2.82–4.64 mm in the other four animals. Groups B and D had a scar on the inner surface of fistulas. Our study shows that the magnetic compression technique based on the T-shaped magnet is a highly useful method to establishing a continuous and stable RVF model in rabbits. [ABSTRACT FROM AUTHOR]

Objective: Surgery for obstetric fistula is a highly effective treatment to restore continence and improve quality of life. However, a lack of data on the cost‐effectiveness of this procedure limits prioritization of this essential treatment. This study measures the effectiveness of fistula surgeries using disability‐adjusted life years (DALYs) averted. Methods: In 2021 and 2022, the Fistula Foundation funded 20 179 fistula surgeries and related procedures at 143 hospitals among 27 countries. We calculated DALYs averted specifically for vesicovaginal fistula and rectovaginal fistula procedure types (n = 13 235 surgeries) by using disability weights from the 2019 Global Burden of Disease study. We based cost calculations on direct treatment expenses, including medical supplies, health provider fees, and preoperative and postoperative care. We measured effectiveness using data on the risk of permanent disability, country‐specific average life spans, and treatment outcomes. Results: The total treatment cost was $7.6 million, and a total of 131 433 DALYs were averted. Thus, the cost per DALY averted—the cost to restore 1 year of healthy life—was $58. For this analysis, we took a cautious approach and weighted only surgeries that resulted in a closed fistula with restored continence. We calculated DALYs averted by country. Limitations of the study include data entry errors inherent in patient logs and lack of long‐term outcomes. Conclusion: The current study demonstrates that obstetric fistula surgery, along with having a significant positive impact on maternal health outcomes, is highly cost‐effective in comparison with other interventions. The study therefore highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. Synopsis: Obstetric fistula treatment is highly cost‐effective. The current study highlights the benefits of prioritizing fistula treatment as part of the global agenda for maternal health care. [ABSTRACT FROM AUTHOR]

As an innovative treatment, stapled transperineal rectovaginal fistula repair (STR) for rectovaginal fistula (RVF) has demonstrated effectiveness in preliminary reports. This study aims to compare STR with rectal mucosal advancement flap repair (RAF), a widely utilized surgical procedure, for the surgical outcome of the low- and mid-level RVF. In this retrospective cohort study, patients with low- and mid-level RVF who underwent STR or RAF were included from both the Sixth Affiliated Hospital of Sun Yat-sen University and Xi'an Daxing Hospital. Among the 99 total patients, 77 underwent STR and 22 underwent RAF. Patient demographics, operative data, and outcomes were collected and analyzed. Recurrence rate and associated risk factors were evaluated. There were no statistically significant differences among patients in terms of clinical characteristics like age, BMI, aetiology, and fistula features. During the follow-up period of 20 months (interquartile range 3.0–41.8 months), a total of 28 patients relapsed, with a significantly lower recurrence rate in the STR group (20.8 %) than in the RAF group (54.6 %) (P = 0.005). In the multivariate Cox analysis, STR was an independent protective factor against recurrence (HR: 0.37, 95%CI: 0.17–0.79, P = 0.01). Logistic regression indicated that there was no statistically significant difference between these two procedures in terms of surgical complications (OR: 0.53, 95%CI: 0.19–1.48, P = 0.23). For low- and mid-level RVF, STR may be an alternative option for treatment modality that offers a lower recurrence rate, without observed disadvantage in terms of surgical complication rates. [ABSTRACT FROM AUTHOR]

Radiation-induced rectovaginal fistula (RI-RVF) with associated rectal stricture represents a challenging problem in management. The aim of the present technical note is to describe a surgical technique aimed at minimizing disease recurrence by avoiding radiated tissue in the reconstruction: 1. Tuttle longitudinal incision of posterior vaginal wall with sharp excision of proximally located fistula; 2. Resection of strictured rectum via a combined transvaginal/laparotomy access, reconstruction with Turnbull-Cutait colon pull-through, and delayed handsewn coloanal anastomosis with loop ileostomy; 3. Bridge closure of the posterior vaginal wall by the interposition of a Singapore flap. This approach resulted in a favorable outcome at the 1-year follow-up in one patient with a medical history of gynecological carcinoma status after hystero-salpingo-oophorectomy followed by adjuvant radiation. [ABSTRACT FROM AUTHOR]

Compare the laparoscopic treatment (LT) and the posterior sagittal anorectoplasty treatment (ST) of the rectovaginal fistulas (RvaF) in a single center. We have previously reported feasibility and results of LT in this rare variety of anorectal malformations (ARM) [1–3]. 19 patients were treated between February 2000 and November 2020. Nine underwent a LT and 10 a ST. Both surgical techniques were previously described. [2][4][5] The distal posterior wall of the vagina was kept intact in the LT. A technical change was introduced in the ST for that purpose. The fistula was treated from the inside of the rectum, avoiding the opening of the distal vagina as described for the treatment of a urethra rectal bulbar fistula in males. Age at operation, associated anomalies, sacral ratio index (SR), complications, urinary continence, presence of spontaneous intestinal movements, constipation, soiling and requirements of bowel management program (BMP) were analyzed. Associated anomalies occurred in 17 patients (89.5 %), 63 % of which were urological. Five (26 %) had a SR below 0.4; 4 in the LT group and 1 in the ST group. The mean age at the time of operation was 23.2 (8–59) in ST and 17.6 months (4–32) in LT. Average operative time was 190.4 min for S T (120–334) and 195.8 min (90–270) for LT (p 0.13). One patient in the LT group presented a mild rectal prolapse and 2 a partial wound dehiscence after the ST. Only 15 patients were evaluable for functional results (8 in ST and 7 in LT). Mean follow up was 83 months (12–197). All patients are clean with a bowel management program. Five of the 7 patients undergoing a LT had a bad prognosis (SR < 0,4). Three (43 %) are clean with diet or any treatment, 3 (43 %) using laxatives or enemas and 1 (14 %) with a trans anal irrigation system. Only 1 of the 8 patients in the STgroup had a bad prognosis. Six (40 %) needed a diet; 4 (50 %) laxatives or enemas and 1 (10 %) a cecostomy button for antegrade enemas. Patients with RvaF had a high index of associated anomalies. The difference of operative time was not statistically significative. No differences in functional results between both groups were observed. LT is a valid option to treat RvaF. [ABSTRACT FROM AUTHOR]

Abstract Background Rectovaginal fistula (RVF) is an abnormal channel formed by epithelial tissue between the anterior wall of the rectum and the posterior wall of the vagina, which manifests as vaginal gassing and defecation. It is one of the common complications of female pelvic surgeries. With the increased number of proctectomies for rectal cancer, the number of postoperative rectovaginal fistulas also increases. Once RVF occurs, the failure rate is still high with various treatments available. RVF causes great suffering to women and is still a major problem in treatment. Therefore, it is significant for female rectal cancer patients to prevent RVF after rectal cancer surgery. In this study, we introduce a new method to prevent RVF during rectal cancer radical operation. Methods In this randomized controlled trial (RCT), all operations are performed according to the principle of total mesorectal excision (TME) radical resection in rectal cancer surgery. All eligible participants will be divided into two groups: the experimental group and the control group. Experimental group: the anterior rectal wall of about 1 cm distal to the anastomosis was dislocated. Before the anastomosis of the rectal end, a fat flap (usually left side) containing the ovarian vascular pedicle was dislocated, measured by 10–15 cm in length and 2 cm in width. The fat flap containing the ovarian vascular pedicle was packed and fixed anterior to the anastomotic stoma with fibrin glue. Control group: surgery will be carried out in accordance with the TME principle. Participants will be compared on several variables, including the incidence of RVF after operation (primary outcomes), the occurrence time of postoperative RVF, the occurrence time of RVF after stoma closure, and other postoperative complications, such as anastomotic leakage, chylous leakage, and intestinal obstruction (secondary outcomes). The follow-up data collection will be conducted according to the follow-up time point, and the baseline data will also be collected for follow-up analysis. By comparing the incidence of rectovaginal leakage between the experimental group and the control group, we aim to explore the feasibility of this method for the prevention of postoperative RVF. Discussion This RCT will explore the feasibility of packing with a laparoscopic dislocated fat flap containing an ovarian vascular pedicle anterior to the anastomotic stoma after rectal cancer surgery to prevent RVF. Trial registration Chinese Clinical Trial Registry (ChiCTR) registration ChiCTR2000031449. Registered on June 26, 2019. All items of the WHO Trial registration data set can be found within the protocol.

Abstract Introduction Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. Objectives A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment. Subjects and methods The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ). Results The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn’s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI. Conclusion CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.

Background: Rectovaginal fistula (RVF) is an abnormal channel formed by epithelial tissue between the anterior wall of the rectum and the posterior wall of the vagina, which manifests as vaginal gassing and defecation. It is one of the common complications of female pelvic surgeries. With the increased number of proctectomies for rectal cancer, the number of postoperative rectovaginal fistulas also increases. Once RVF occurs, the failure rate is still high with various treatments available. RVF causes great suffering to women and is still a major problem in treatment. Therefore, it is significant for female rectal cancer patients to prevent RVF after rectal cancer surgery. In this study, we introduce a new method to prevent RVF during rectal cancer radical operation. Methods: In this randomized controlled trial (RCT), all operations are performed according to the principle of total mesorectal excision (TME) radical resection in rectal cancer surgery. All eligible participants will be divided into two groups: the experimental group and the control group. Experimental group: the anterior rectal wall of about 1 cm distal to the anastomosis was dislocated. Before the anastomosis of the rectal end, a fat flap (usually left side) containing the ovarian vascular pedicle was dislocated, measured by 10–15 cm in length and 2 cm in width. The fat flap containing the ovarian vascular pedicle was packed and fixed anterior to the anastomotic stoma with fibrin glue. Control group: surgery will be carried out in accordance with the TME principle. Participants will be compared on several variables, including the incidence of RVF after operation (primary outcomes), the occurrence time of postoperative RVF, the occurrence time of RVF after stoma closure, and other postoperative complications, such as anastomotic leakage, chylous leakage, and intestinal obstruction (secondary outcomes). The follow-up data collection will be conducted according to the follow-up time point, and the baseline data will also be collected for follow-up analysis. By comparing the incidence of rectovaginal leakage between the experimental group and the control group, we aim to explore the feasibility of this method for the prevention of postoperative RVF. Discussion: This RCT will explore the feasibility of packing with a laparoscopic dislocated fat flap containing an ovarian vascular pedicle anterior to the anastomotic stoma after rectal cancer surgery to prevent RVF. Trial registration: Chinese Clinical Trial Registry (ChiCTR) registration ChiCTR2000031449. Registered on June 26, 2019. All items of the WHO Trial registration data set can be found within the protocol. [ABSTRACT FROM AUTHOR]

Copyright of Revista Cientifica de la Facultade de Veterinaria is the property of Universidad del Zulia, Facultad de Ciencias Veterinarias and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. Objectives: A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment. Subjects and methods: The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ). Results: The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn's disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI. Conclusion: CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF. [ABSTRACT FROM AUTHOR]

Copyright of Kocatepe Veterinary Journal / Kocatepe Veteriner Dergisi is the property of Afyon Kocatepe University, Faculty of Veterinary Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recto–vaginal fistula (RVF) associated with atresia ani (AA) are congenital anomalies in which fecal and urinary output occurs through the vulvar region. In this study, 17 ruminants (lamb n=9, calf n=8) constituting type II AA–associated RVF cases were included. The cases were evaluated clinically, radiographically and ultrasonographically. Clinical findings included tenesmus, feces in the perivulval area, abdominal distension, partial perineal swelling and hematochezia. The abdomen and pelvis were evaluated by direct radiography and gaseous distension, dilated colon, moderate or severe megacolon were diagnosed. Using radiographic assessment of the distance between the rectum blind pouch and perineum, AA was typed and all cases were diagnosed as Type II AA. Ultrasonography was used to classify RVF and recto–lower fistula was diagnosed in all cases evaluated. All operations were performed by anoplasty using the rectal–pull through technique. No complications were encountered during the postoperative follow–up period. The aim of this study was to provide information about the diagnosis, treatment and use of radiography and ultrasonography in Type II AA with RVF in lambs and calves.

Aim. In this study, we present a new method for treating cases of rectovaginal fistula that will be added to the medical literature. In this study, we examine two patients with low vaginal fistula from their initial clinic visit until the end of their follow-up period. Methods and materials. Two patients who had undergone a normal vaginal delivery one year prior presented to our clinic with complaints of offensive vaginal discharge and distressing symptoms, including stool leakage and vaginal flatulence. They consented to experience this new technique for the treatment of their low vaginal fistula. Results. Gebrel-Mostafa technique has numerous beneficial effects, including the elimination of the need for a second operation to remove the plastic Avis, which functions as a seton. In addition, it is characterized by a short duration of operation, the inability to form an abscess or hematoma, and a rapid return to normal life. Avis plastic acts as an auto-tightening and auto-cutting material, and the patient or doctor can tighten it. Finally, it is less expensive, and there is no requirement to use the labial Martius flap. Conclusion. This (Gebrel-Mostafa) technique yields positive outcomes with no significant morbidity and is feasible to perform. The absence of incontinence, abscess formation, and sepsis in the wound may be attributable to the wide range of antibiotics administered to the patients.

Prolonged foreign body impaction resulting in a rectovaginal fistula is one of the rare case scenarios presenting nowadays due to increased awareness and widespread availability of health care centers. Also, the taboo of reporting to healthcare personnel for rare gynecological problems is also decreasing. This patient reported with a foreign body in the form of a hair clutcher inserted in her vagina 3 years back by her boyfriend. She presented with complaints of itching, foreign body sensation in the vagina, and pain abdomen in the supra pubic area for 3 months after she got married. The diagnosis was confirmed on per rectal and per vaginal examination followed by contrast‑enhanced computed tomography pelvis. Intraoperatively, the foreign body was found to be impacted in both rectum and vagina, resulting in a rectovaginal fistula. The fistula was repaired and a diversion colostomy was done. After 12 weeks, colostomy closure was done, and the patient was discharged with no postoperative complications. [ABSTRACT FROM AUTHOR]

Background: A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR™ System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment. Objective: This was a feasibility study performed in a single cadaveric perineum.Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers' fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach. Results: A satisfactory vaginal length was achieved rapidly and safely. Conclusions: We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided. Level of evidence: Not applicable [ABSTRACT FROM AUTHOR]

(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the cervix. Excisional treatments are often curative, and complications are typically rare and minor. (2) Methods: The loop electrosurgical excision procedure (LEEP) is the standard method used for conservative surgery in high-grade cervical dysplasia. It entails the excision of the specific area of the cervix where the abnormal cells are present. The procedure employs a wire loop carrying an electrical current to remove the affected tissue. (3) Results: Excisional treatments, such as LEEP, have shown to be effective in treating high-grade cervical dysplasia. They have a high success rate in eliminating abnormal cells and reducing the risk of cervical cancer. Complications associated with LEEP are infrequent and usually minor. Short-term complications may include bleeding, which can be managed easily. Long-term complications may involve cervical canal stenosis, which can impact fertility. (4) Conclusions: Conservative surgery, particularly the loop electrosurgical excision procedure (LEEP), is the preferred and effective treatment for high-grade cervical dysplasia caused by HPV infection. It offers a high cure rate with rare and minor complications. While short-term bleeding is a common occurrence, it is manageable. Long-term complications such as cervical canal stenosis may impact fertility. However, an extremely rare and possibly unique complication described in this case is the development of a vaginorectal fistula. This complication is likely due to indirect thermal injury resulting from compromised tissue. Further research is needed to better understand and prevent such complications.

(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the cervix. Excisional treatments are often curative, and complications are typically rare and minor. (2) Methods: The loop electrosurgical excision procedure (LEEP) is the standard method used for conservative surgery in high-grade cervical dysplasia. It entails the excision of the specific area of the cervix where the abnormal cells are present. The procedure employs a wire loop carrying an electrical current to remove the affected tissue. (3) Results: Excisional treatments, such as LEEP, have shown to be effective in treating high-grade cervical dysplasia. They have a high success rate in eliminating abnormal cells and reducing the risk of cervical cancer. Complications associated with LEEP are infrequent and usually minor. Short-term complications may include bleeding, which can be managed easily. Long-term complications may involve cervical canal stenosis, which can impact fertility. (4) Conclusions: Conservative surgery, particularly the loop electrosurgical excision procedure (LEEP), is the preferred and effective treatment for high-grade cervical dysplasia caused by HPV infection. It offers a high cure rate with rare and minor complications. While short-term bleeding is a common occurrence, it is manageable. Long-term complications such as cervical canal stenosis may impact fertility. However, an extremely rare and possibly unique complication described in this case is the development of a vaginorectal fistula. This complication is likely due to indirect thermal injury resulting from compromised tissue. Further research is needed to better understand and prevent such complications. [ABSTRACT FROM AUTHOR]

Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. Considering the low efficiency of treatment and the high risk of recurrence, the question of possible methods to improve the results occurs. In our review, we analyzed both modifiable and non-modifiable factors which may influence the treatment, healing rate and future fate of the patients. Taking into account all analyzed risk factors, including age, comorbidities, smoking status, microbiology, medications, stoma and stool features, we are aware that rectovaginal fistula's treatment must be individualized and holistic. In cases of poorly healing RVF, the drainage of feces, the use of antibiotic prophylaxis or the implementation of estrogen therapy may be useful. Moreover, microbiome research in women with RVF and towards estrogen therapy should be performed in order to create treatment algorithms in women with fistulae. Those interventions, in our opinion, may significantly improve the outcome of the patients. [ABSTRACT FROM AUTHOR]

Background: Crohn's-related rectovaginal fistulas (RVF) greatly impact quality of life and are notoriously difficult to treat. The aim of this study was to assess the burden of recurrent episodes of care for RVF and its economic impact. Methods: A retrospective observational cohort study of administrative US claims databases was conducted. Eligible patients were female adults, with a diagnosis code for Crohn's disease with or without a diagnosis/procedural code for RVF. For the RVF cohort, rates of recurrence of RVF episodes of care were estimated using Kaplan–Meier analyses. Healthcare resource utilization (HCRU) and direct healthcare costs were compared between the RVF cohort and RVF-free cohort. Results: Mean ages in the RVF cohort (n = 963) and RVF-free cohort (n = 56,564) were 47.2 and 50.8 years, with a mean follow-up period of 58.7 and 49.8 months, respectively. For the RVF cohort, the probability of having a second RVF episode of care within 2 years of the first one was estimated to be 35.9% and of having a third episode within 2 years of the second was 47.8%. During the first 2 years, the RVF cohort had 67% more inpatient admissions than the RVF-free cohort with each RVF episode of care being associated with 16% more admissions. The estimated incremental cost associated with having RVF was US$17,561, with an incremental cost of US$11,607 for each additional RVF episode of care. Conclusions: This real-world study highlights the significant impact of RVF in patients with Crohn's disease with regard to repeat interventions and associated HCRU and direct healthcare costs, suggesting novel therapeutics are needed in this patient population. [ABSTRACT FROM AUTHOR]

In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). This novel approach aims to deal with the difficulties associated with RVF, a medically complex condition with a lack of effective treatment options. We present the case of a 45-year-old female patient with a 15-year history of Crohn's disease (CD). During the preceding eight years, she had encountered substantial difficulties resulting from a rectovaginal fistula (RVF) that was active and considerable in size (measuring 3.5 cm in length and 1 cm in width). Her condition was accompanied by tissue alterations at both the vaginal and rectal openings. Following her admission to our hospital, the patient's case was discussed during both surgical and multidisciplinary hospital team (IRB) meetings. The team decided to combine a modified Martius flap with autologous MFAT containing MSCs. The results were remarkable, leading to comprehensive anatomical and clinical resolution of the RVF. Equally significant was the improvement in the patient's overall quality of life and sexual satisfaction during the one-year follow-up period. The integration of the modified Martius flap with MFAT emerges as a highly promising approach for addressing CD-related RVFs that had historically been, and still are, difficult to treat, given their often refractory nature and low healing success rates. [ABSTRACT FROM AUTHOR]

Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. With insufficient clinical data due to the rare entity, the present state of treatments for RVFs was reviewed especially form the point of factors to determine management, classifications, principle of treatment, conservative and surgical treatments with outcomes. Size, fistula localization and etiology, type of fistula; “simple” or “complex,” status of anal sphincter complex and surrounding tissue, presence or absence of inflammation, presence of diverting stoma, previous attempted repair and radiation therapy, patient's condition with co-morbidities, and surgeon's experience are important factors to determine the management of RVF. The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period. Anal sphincter damage might need a repair of sphincter muscles along with RVF repair. Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient's pain. Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs.

Abstract Background Rectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn’s disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer. Case presentation A 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation. Conclusions The patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.

Prolonged foreign body impaction resulting in a rectovaginal fistula is one of the rare case scenarios presenting nowadays due to increased awareness and widespread availability of health care centers. Also, the taboo of reporting to healthcare personnel for rare gynecological problems is also decreasing. This patient reported with a foreign body in the form of a hair clutcher inserted in her vagina 3 years back by her boyfriend. She presented with complaints of itching, foreign body sensation in the vagina, and pain abdomen in the supra pubic area for 3 months after she got married. The diagnosis was confirmed on per rectal and per vaginal examination followed by contrast-enhanced computed tomography pelvis. Intraoperatively, the foreign body was found to be impacted in both rectum and vagina, resulting in a rectovaginal fistula. The fistula was repaired and a diversion colostomy was done. After 12 weeks, colostomy closure was done, and the patient was discharged with no postoperative complications.

Aim: Rectovaginal fistulas in patients with Crohn's disease are challenging to manage, and surgical treatment remains the best option for achieving permanent closure of the fistula. Biologicals are now used routinely for patients with Crohn's disease. The aim of this study was to investigate the surgical procedures used by us to treat rectovaginal fistula in patients with Crohn's disease in the era of biologicals. Method: Patients with Crohn's disease who underwent surgery for a rectovaginal fistula between 2010 and 2020 were included in this retrospective study and were identified from a prospectively maintained institutional database. Collected variables included demographics, perioperative and operative variables and data regarding medications used. Success of the procedure was defined as no symptoms at least 6 months after definitive repair and/or stoma closure. Results: Twenty patients (out of 80 referred for evaluation) underwent surgery with intent to close the fistula and had at least 6 months of follow‐up. Mean age was 44 ± 12 years with a median follow‐up duration of 33 months (range 6–130 months). Forty per cent of the patients had a history of at least two surgeries to close the fistula. The overall healing rate was 70% (14/20). The most performed procedure was a transanal rectal advancement flap (7/20), with a success rate of 85%. Conclusion: Rectovaginal fistula in Crohn's disease is difficult to cure; according to our results almost half of these patients have multiple surgeries due to recurrence. Multiple procedures may be offered for this challenging problem in motivated patients. Perioperative diversion should be strongly considered. [ABSTRACT FROM AUTHOR]

The incidence of obstetric anal sphincter injury in the UK is rising. This condition leads to significant morbidity in otherwise healthy women. Significant long-term complications of obstetric anal sphincter injury include anal incontinence, ano-vaginal or recto-vaginal fistula and psychological distress. Current management of third and fourth degree perineal tears post-vaginal birth is primary repair. This article discusses the role of a defunctioning colostomy in women with severe perineal tears in the immediate postnatal period. A defunctioning colostomy is a surgical procedure to open a section of colon (large bowel) onto the abdominal wall; a stoma bag is then worn over this to collect faeces. The rectum and anal canal are not used (defunctioned), while the stoma is in place and the perineum is healing. This article describes the purpose and operative steps of colostomy formation and reviews current published evidence of outcomes in those with colostomy formation for obstetric anal sphincter injury. It also addresses the difference in clinical approach between obstetricians and colorectal surgeons in relation to the management of severe obstetric anal sphincter injury and highlight the need for multidisciplinary input. [ABSTRACT FROM AUTHOR]

Stem cells, with their remarkable capacity for differentiation into diverse cell types, are vital for the development as well as maintenance of health and homeostasis. Two unique abilities set them apart from other cells: self-renewal and the capacity for differentiation. They play important roles in embryogenesis, development, regeneration, and various other processes. Over the last decade, there has been increased interest in their potential use in the treatment of numerous diseases and disorders across multiple fields of medicine in acute, chronic, innate, and acquired diseases. Stem cells are key to maintaining the body's homeostasis and regulating growth and tissue functions. There are several types of stem cells—embryonic, adult, and human-induced pluripotent cells. Currently, mesenchymal stem cells are of great interest due to their regenerative, immunomodulatory, analgesic, and antimicrobial (anti-inflammatory) effects. Recent studies have shown the potent regenerative effect of stem cell therapy in gynecologic diseases such as infertility, Asherman syndrome, lichen sclerosus, polycystic ovary syndrome, premature ovarian insufficiency, genitourinary syndrome of menopause, and rectovaginal fistulas. Moreover, the successful isolation of oogonial stem cells could lead to a revolution in the field of gynecology and the potential treatment of the conditions discussed. This review aims to provide a better understanding of the latest therapeutic options involving stem cells and raise awareness of this promising yet not widely known topic in gynecology and medicine in general. [ABSTRACT FROM AUTHOR]

Background: Management of recurrent rectovaginal fistula (rRVF) remains challenging despite the good results of graciloplasty reported in the literature. However, little is known about how to avoid a permanent stoma if graciloplasty fails. The aim of our study was to report the management of rRVF after failure of graciloplasty. Methods: A retrospective study was performed on consecutive patients with rRVF after failure of graciloplasty treated at our institution in January 2005–December 2021. Results: There were 19 patients, with a median age at graciloplasty of 39 years (range 25–64 years). Etiologies of RVF were Crohn's disease (CD) (n = 10), postoperative (n = 5), post-obstetrical (n = 3), and unknown (n = 1). After failure of graciloplasty, 45 new procedures were performed, all of them with a covering stoma: trans-anal repairs (n = 31), delayed colo-anal anastomosis (DCAA) (n = 4), biological mesh interposition (n = 3), second graciloplasty (n = 3), stoma only (n = 2) and redo ileal pouch–anal anastomosis (IPAA) (n = 2). One patient was not re-operated on and instead treated medically for CD. After a mean follow-up of 63 ± 49 months, success (i.e., absence of stoma or RVF) was obtained in 11 patients (58%): 4/4 DCAA (100%), 5/31 after local repair (16%), 1 after stoma creation alone (50%) and 1 after redo IPAA (50%). Second graciloplasty and biologic mesh interposition all failed. All 8 patients with failed intervention had CD. Conclusions: In cases of rRVF after failed graciloplasty, reoperation is possible, although the chance of success is relatively low. The best results were obtained with DCAA. CD is a predictor of poor outcome. [ABSTRACT FROM AUTHOR]

Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women's suffering.