Department of Surgery, Caritas Clinic St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany.
Tech Coloproctol. 2019 Jan;23(1):43-52. doi: 10.1007/s10151-018-1918-7. Epub 2019 Jan 2.
The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD).
A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected.
A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients).
GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.
本研究旨在评估内收肌移位术（GMT）治疗炎症性肠病（IBD）患者复发性阴道直肠瘘、直肠阴道瘘、直肠尿道瘘和袋状阴道瘘的疗效。
对 2000 年至 2018 年间由一位外科医生施行 GMT 的 IBD 患者进行回顾性研究。收集愈合率、并发症、辅助手术和造口关闭率的随访数据。
共 30 名女性和 2 名男性患者接受了 GMT。所有患者的瘘管均与克罗恩病有关。在 1 名女性患者中，初次修复失败后需要对另一侧内收肌进行转位。初次愈合率为 47%（15/32），确定性愈合率（在数据收集时和进行二次手术后愈合）为 71%（23/32）。17 名患者（53%）因瘘管持续或复发而进行了额外的手术。至少有 7 名患者（21%）出现并发症，包括 1 例因内收肌缺血导致的伤口感染。31 例有造口的患者中，有 18 例（患者的 58%）成功关闭造口。
GMT 治疗 IBD 患者复发性和复杂肛门直肠瘘最终在近 2/3 的患者中获得成功。
