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KMID : 0356719990150010065
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Journal of the Korean Society of Coloproctology
1999 Volume.15 No. 1 p.65 ~ p.71
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Repair of Rectovaginal Fistulas
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Park Won-Kap
Hwang Do-Yeon
Kim Khun-Uk
Lee Kwang-Ryul
Yoo Jung-Jun
Lim Seok-Won
Kim Hyun-Sik
Lee Jong-Kyun
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Abstract
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Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25∼56) years. The mean follow-up after operation was 33 (range, 8∼62) months. The etiology of the fistula in the majority of patients was
obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap
advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient’s history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should
be performed.
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KEYWORD
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Rectovaginal fistula, Mucosal advancement flap, Rectovaginal septum, Sphincteroplasty, Perineal body reconstruction
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