Gracilis Muscle Transposition for Fistulas Between the Rectum and Urethra or Vagina
- 1 September 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 49 (9), 1316-1321
- https://doi.org/10.1007/s10350-006-0585-3
Abstract
This study was designed to assess the efficacy of gracilis muscle transposition in repairing rectovaginal and rectourethral fistulas. Data were retrieved from a retrospective chart review of patients who underwent gracilis muscle transposition for fistulas between the rectum and urethra/vagina. All patients had fecal diversion as a preliminary or concurrent step to fistula repair. Follow-up data were gathered from outpatient clinic visits. Success was defined as a healed fistula after stoma closure. Six females and three males, aged 30 to 64 years, underwent gracilis muscle transpositions from 1999 to 2005. One pouch-vaginal, three rectourethral, and five rectovaginal fistulas were repaired. The etiologies were Crohn's disease (n = 2), iatrogenic injury to the rectum during radical prostatectomy (n = 2), previous pelvic irradiation for rectal cancer (n = 2) or for cervical cancer (n = 1), recurrent perianal abscesses with fistulas (n = 1), and obstetric tear (n = 1). Seven patients underwent previous medical and surgical repair attempts. There were no intraoperative complications. Postoperative complications included perineal wound infection (n = 1) and at the colostomy closure (n = 2). There were no long-term sequelae. At a median follow-up period of 14 (range, 1-66) months since stoma closure, the fistula healed in seven patients. One patient refused ileostomy closure. One patient with severe Crohn's proctitis has a persistent rectovaginal fistula. Gracilis muscle transposition is a viable option for repairing fistulas between the urethra, vagina, and the rectum, especially after failed perineal or transanal repairs. It is associated with low morbidity and a good success rate. Underlying Crohn's disease and previous radiation are associated with poor prognosis.Keywords
This publication has 19 references indexed in Scilit:
- MAJOR SURGERY TO MANAGE DEFINITIVELY SEVERE COMPLICATIONS OF SALVAGE CRYOTHERAPY FOR PROSTATE CANCERJournal of Urology, 2000
- Management of iatrogenic rectourethral fistulaDiseases of the Colon & Rectum, 1999
- High-dose rate interstitial with external beam irradiation for localized prostate cancer – results of a prospective trialRadiotherapy and Oncology, 1998
- Treatment of rectovaginal fistulas that has failed previous repair attemptsDiseases of the Colon & Rectum, 1995
- Surgical repair of rectovaginal fistulas in patients with Crohn's diseaseDiseases of the Colon & Rectum, 1991
- Repair of simple rectovaginal fistulasDiseases of the Colon & Rectum, 1988
- Endorectal advancement flap for treatment of simple rectovaginal fistulaDiseases of the Colon & Rectum, 1982
- Gracilis Muscle Flap for Closure of Rectourethral FistulaJournal of Urology, 1979
- A method of treating post-irradiation rectovaginal fistulasBritish Journal of Surgery, 1978
- Sartorius muscle interposition for the treatment of the radiation-induced vaginal fistulaAmerican Journal of Obstetrics and Gynecology, 1969