Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases

被引:71
作者
Ulrich, Dietmar [1 ]
Roos, Joachim [3 ]
Jakse, Gerhard [2 ]
Pallua, Norbert [1 ]
机构
[1] Univ Technol, Dept Plast Surg, Burn Unit, Univ Hosp,Fac Med, D-52074 Aachen, Germany
[2] Univ Technol, Dept Urol, Univ Hosp, Fac Med, D-52074 Aachen, Germany
[3] Univ Technol, Dept Gynaecol, Univ Hosp, Fac Med, D-52074 Aachen, Germany
关键词
Crohn's disease; Gracilis flap; Recto-urethral fistula; Rectovaginal fistula; SURGICAL-MANAGEMENT; RECTOURINARY FISTULA; PERINEAL SINUS; REPAIR; FLAP; TRANSPOSITION; RADIOTHERAPY; EXPERIENCE;
D O I
10.1016/j.bjps.2008.11.067
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Several surgical procedures for the repair of fistulas between the rectum and the urethra or vagina have been reported. Our study was designed to assess the efficacy of the gracilis muscle flap in repairing recto-urethral and rectovaginal fistulas. Methods: Gracilis muscle interposition flaps were performed in 35 patients (aged 38-78 years, mean: 58 years) using a perineal. approach. Nine patients had rectovaginal. fistulas due to Crohn's disease (n = 3), previous surgery and pelvic irradiation for rectal (n = 2) or cervical cancer (n = 4). Twenty-six fistulas were recto-urethral. The aetiologies were Crohn's disease (n = 4), brachytherapy after prostate cancer (n = 14), iatrogenic injury to the rectum during radical retropubic prostatectomy (n = 4), transurethral resection of the prostate (n = 2) and recurrent peri-anal abscesses with fistulas (n = 2). Twenty-five patients had undergone previous repair attempts; of these four underwent multiple procedures. Patient outcomes were assessed after surgical, repair. The success rate was measured as the percentage of patients with a heated fistula after stomal, closure. Results: The mean follow-up was 28 +/- 15 months from muscle transposition and 22 +/- 14 months from stomal, closure. Fistula closure with no recurrence could be achieved in 33 patients (94%). Two of the seven patients (29%) with Crohn's disease had a persistent fistula. There were neither intra-operative complications nor problems related to muscle desinsertion surgery. Conclusions: Recto-urethral, and rectovaginal fistula closure using the perineal approach with pedicled gracilis muscle interposition is associated with minimal morbidity and a high success
引用
收藏
页码:352 / 356
页数:5
相关论文
共 34 条
[1]   Experience with 30 posttraumatic rectourethral fistulas: Presentation of posterior transsphincteric anterior rectal wall advancement [J].
AlAli, M ;
Kashmoula, D ;
Saoud, IJ .
JOURNAL OF UROLOGY, 1997, 158 (02) :421-424
[2]  
Boushey RP, 1998, CAN J SURG, V41, P241
[3]   SARTORIUS MUSCLE INTERPOSITION FOR TREATMENT OF RADIATION-INDUCED VAGINAL FISTULA [J].
BYRON, RL ;
OSTERGARD, DR .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1969, 104 (01) :104-+
[4]   SHORT GRACILIS MYOCUTANEOUS FLAPS FOR VULVOPERINEAL AND INGUINAL RECONSTRUCTION [J].
CHEN, SHT ;
HENTZ, VR ;
WEI, FC ;
CHEN, YR .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1995, 95 (02) :372-377
[5]  
DIEZ AB, 2004, ACTAS UROL ESP, V28, P466
[6]   The York Mason approach to repair of iatrogenic rectourinary fistulae [J].
Fengler, SA ;
Abcarian, H .
AMERICAN JOURNAL OF SURGERY, 1997, 173 (03) :213-217
[7]   RECTOURINARY FISTULA - PRINCIPLES OF MANAGEMENT AND A TECHNIQUE OF SURGICAL CLOSURE [J].
GOODWIN, WE ;
TURNER, RD ;
WINTER, CC .
JOURNAL OF UROLOGY, 1958, 80 (04) :246-254
[8]   GRACILIS MUSCLE REPAIR OF RECTOVAGINAL FISTULA AFTER RESTORATIVE PROCTOCOLECTOMY - REPORT OF 2 CASES [J].
GORENSTEIN, L ;
BOYD, JB ;
ROSS, TM .
DISEASES OF THE COLON & RECTUM, 1988, 31 (09) :730-734
[9]   Surgical management of rectourethral fistula [J].
Gupta, Gaurav ;
Kumar, Santosh ;
Kekre, Nitin S. ;
Gopalakrishnan, Ganesh .
UROLOGY, 2008, 71 (02) :267-271
[10]   THE INCIDENCE AND MANAGEMENT OF RECTAL INJURY ASSOCIATED WITH RADICAL PROSTATECTOMY IN A COMMUNITY-BASED UROLOGY PRACTICE [J].
HARPSTER, LE ;
ROMMEL, FM ;
SIEBER, PR ;
BRESLIN, JA ;
AGUSTA, VE ;
HUFFNAGLE, HW ;
POHL, CE .
JOURNAL OF UROLOGY, 1995, 154 (04) :1435-1438