Pai Vishwas, Desouza Ashwin, De Menezes Jean Louis, Saklani Avanish
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Indian J Surg Oncol. 2015 Sep;6(3):256-8. doi: 10.1007/s13193-015-0398-8. Epub 2015 Mar 18.
Rectovaginal fistula [RVF] is a devastating complication of anterior resection whose incidence worldwide is on a rise with widespread use of staplers for the rectal anastomosis. It is a special surgical challenge for the treating surgeon with limited suitable options available to treat this difficult situation. As there is no consensus on its management, most often patient ends up with permanent stoma and overall inferior quality of life. We are presenting a case of post anterior resection RVF which was treated with intersphincteric resection followed by hand sewn coloanal anastomosis. An intersphincteric resection avoids dissection in a previously violated rectovaginal plane and improves chances of sphincter preservation. A well vascularized colonic graft with hand sewn coloanal anastomoses well below the site of fistula and omental interposition further avoids the chances of recurrence of fistula.
直肠阴道瘘（RVF）是前切除术的一种严重并发症，随着吻合器在直肠吻合术中的广泛应用，其在全球的发病率呈上升趋势。对于治疗外科医生而言，这是一项特殊的手术挑战，可供治疗这种棘手情况的合适选择有限。由于在其治疗方面尚无共识，大多数患者最终会形成永久性造口，生活质量整体较差。我们报告一例前切除术后直肠阴道瘘病例，该病例采用括约肌间切除术，随后进行手工缝合结肠肛管吻合术进行治疗。括约肌间切除术避免了在先前受损的直肠阴道平面进行解剖，提高了保留括约肌的几率。带有手工缝合结肠肛管吻合的血运良好的结肠移植物，吻合部位远低于瘘口，大网膜植入进一步避免了瘘复发的可能性。
