International Urogynecology Journal

, Volume 30, Issue 12, pp 2195–2198 | Cite as

Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis

  • Jiri HanacekEmail author
  • Lukas Havluj
  • Jan Drahonovsky
  • Iva Urbankova
  • Petr Krepelka
  • Jaroslav Feyereisl
IUJ Video


Introduction and hypothesis

Endometriosis is a gynecological condition characterized by endometrial tissue outside of the uterus. It affects up to 15% of women of reproductive age. In the case of bowel infiltration, about 90% of lesions are localized on the sigmoid colon or the rectum and may interfere with bowel function. Three surgical approaches are possible: (1) shaving technique, (2) discoid resection of the nodule, and (3) segmental resection with end-to-end anastomosis. A rectovaginal fistula is feared as a postoperative complication mainly in simultaneous resection of the vaginal and the rectosigmoid nodules. Its prevention is a two-step surgery (the first operation on the vagina and the second on the colon) or a preventive colostomy, both of which are often thought to be too invasive for a benign condition. Herein, we suggest a one-step surgery to prevent its development.


In three women, a concomitant laparoscopic resection of the vaginal and rectosigmoid endometrial nodule was completed with interposition of a mesorectal flap.


All surgeries were uncomplicated with no rectovaginal fistula in the postoperative period.


In the hands of skilled surgeons, this one-step technique can be used to prevent rectovaginal fistula development.


Bowel endometriosis Vaginal endometriosis Rectovaginal fistula Mesorectal flap 



This work would not be possible without our surgical nurses and other colleagues, who took care of our patients.

Compliance with ethical standards

Conflicts of interest


Supplementary material


(MP4 67148 kb)


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Institute for the Care of Mother and ChildPragueCzech Republic
  2. 2.Third Faculty of MedicineCharles UniversityPragueCzech Republic
  3. 3.Department of General Surgery, Third Faculty of Medicine and University Hospital Královské VinohradyCharles UniversityPragueCzech Republic

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