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Surgical management of rectovaginal fistula after stapled transanal rectal resection for prolapsed hemorrhoids

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Abstract

Introduction and hypothesis

Rectovaginal fistula is an epithelium-lined direct communication route between the vagina and the rectum. The gold standard of fistula management is surgical treatment. Rectovaginal fistula after stapled transanal rectal resection (STARR) may be challenging to treat, due to the extensive scarring, the local ischemia, and the risk of rectal stenosis. We aimed to present a case of iatrogenic rectovaginal fistula after STARR that was successfully treated with a transvaginal primary layered repair and bowel diversion.

Methods

A 38-year-old woman was referred to our division for continuous fecal discharge through her vagina that developed a few days after she had a STARR for prolapsed hemorrhoids. Clinical examination revealed a 2.5 cm-wide direct communication between the vagina and rectum. After proper counseling, the patient was admitted to transvaginal layered repair and temporary laparoscopic bowel diversion

Results

No surgical complications were observed. The patient was successfully discharged home on postoperative day 3. Bowel diversion was reversed after 2 months. At the current follow-up (6 months), the patient is asymptomatic and without recurrence.

Conclusions

The procedure was successful in obtaining anatomical repair and relieving symptoms. This approach represents a valid procedure for the surgical management of this severe condition.

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Authors and Affiliations

  1. Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi, 33 20900, Monza, Italy

    Matteo Frigerio, Marta Barba & Alice Cola

  2. University of Milano-Bicocca, Monza, Italy

    Marta Barba, Silvia Volontè, Giuseppe Marino, Tomaso Melocchi & Desirèe De Vicari

Authors
  1. Matteo Frigerio
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  2. Marta Barba
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  3. Silvia Volontè
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  4. Giuseppe Marino
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  5. Tomaso Melocchi
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  6. Desirèe De Vicari
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  7. Alice Cola
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Corresponding author

Correspondence to Marta Barba.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

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Supplementary Information

Transvaginal primary layered repair of rectovaginal fistula after stapled transanal rectal resection for prolapsed hemorrhoids. (MP4 26887 kb)

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Frigerio, M., Barba, M., Volontè, S. et al. Surgical management of rectovaginal fistula after stapled transanal rectal resection for prolapsed hemorrhoids. Int Urogynecol J 34, 2325–2327 (2023). https://doi.org/10.1007/s00192-023-05490-9

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  • DOI: https://doi.org/10.1007/s00192-023-05490-9

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