Techniques in Coloproctology

, Volume 22, Issue 11, pp 887–890 | Cite as

Fasciocutaneous lotus petal flap in the treatment of chronic pouch-vaginal fistula in ulcerative colitis

  • L. Sofo
  • A. E. Potenza
  • D. Cervelli
  • F. SacchettiEmail author
  • N. Ursino
Trick of the Trade


Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical gold standard for patients with ulcerative colitis and familial adenomatous polyposis who require proctocolectomy [1].

Development of a pouch-vaginal fistula (PVF) is a feared complication of this surgery. PVF appears in about 4–16% of patients who have had IPAA, and is present in 21–30% in the case of concomitant pouch failure. Early fistulae are most likely associated with technical aspects of surgery, whereas late fistulae result from a diverse range of other causes (e.g., local inflammation, chronic anastomic leakage, and radiation damage) [2].

Surgical factors

A tension-free anastomosis with good blood supply is crucial for successful healing of bowel anastomoses. Initial reports noted a higher incidence of PVF with a stapled anastomosis, probably due to staple line being too close to the vaginal wall [3]. In contrast, two randomized trials found no difference between techniques [4]...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Abdominal Surgery DepartmentFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of RomeRomeItaly
  2. 2.Maxillofacial Surgery DepartmentFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of RomeRomeItaly
  3. 3.School of General SurgeryCatholic University of RomeRomeItaly

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