Pata Giacomo, Pasini Mario, Roncali Stefano, Tognali Daniela, Ragni Fulvio
Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
Int J Surg Case Rep. 2014;5(8):527-31. doi: 10.1016/j.ijscr.2014.04.014. Epub 2014 Jun 19.
Rectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures.
We report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures.
This technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum.
In our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair.
直肠阴道瘘（RVF）是各种盆腔外科手术中一种罕见但使人衰弱的并发症。
我们报告一例45岁女性患者，她接受了经肛门吻合器直肠切除术（STARR），术后并发30毫米直肠阴道瘘（RVF）。我们通过经会阴入路和耻骨尾骨肌置入成功修复了瘘管。七个月后，我们确认瘘管完全愈合，患者生活质量良好。我们详细描述了我们的技术，显示出其相对于替代缝合、皮瓣重建或切除术的优势。
该技术操作相当简单且保守。在直肠阴道间隙解剖过程中，耻骨尾骨肌很容易识别，通过单根缝线对该肌肉进行无张力近似是替代直肠阴道隔的一种简便方法。
根据我们的经验，耻骨尾骨肌置入术是一种有效的直肠阴道间隙重建技术，应被视为直肠阴道瘘修复的可行解决方案。
