Advertisement

Gracilis muscle transposition for treatment of recurrent anovaginal, rectovaginal, rectourethral, and pouch–vaginal fistulas in patients with inflammatory bowel disease

  • S. Korsun
  • G. Liebig-Hoerl
  • A. Fuerst
Original Article
  • 14 Downloads

Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.

Keywords

Crohn disease Fecal incontinence Surgical flaps Surgical stomas 

Notes

Acknowledgements

S. Korsun contributed to study design, collected and analyzed the data, and wrote the manuscript. G. Liebig-Hoerl assisted in data collection. A. Fuerst supervised data collection, data analysis, the study, and corrected the paper.

Funding

The authors did not receive any funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest in connection with this study.

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.

References

  1. 1.
    Scharl M, Huber N, Lang S et al (2015) Hallmarks of epithelial to mesenchymal transition are detectable in Crohn’s disease associated intestinal fibrosis. Clin Transl Med 4:1CrossRefGoogle Scholar
  2. 2.
    Bataille F, Rohrmeier C, Bates R et al (2008) Evidence for a role of epithelial mesenchymal transition during pathogenesis of fistulae in Crohn’s disease. Inflamm Bowel Dis 14(11):1514–1527CrossRefGoogle Scholar
  3. 3.
    Siegmund B, Feakins RM, Barmias G et al (2015) Results of the fifth scientific workshop of the ECCO (II): pathophysiology of perianal fistulizing disease. J Crohn’s Colitis 10(4):377–386CrossRefGoogle Scholar
  4. 4.
    Chen XB, Liao DX, Luo CH et al (2013) [Prospective study of gracilis muscle repair of complex rectovaginal fistula and rectourethral fistula]. Zhonghua Wei Chang Wai Ke Za Zhi 16(1):52–55PubMedGoogle Scholar
  5. 5.
    Lefevre JH, Bretagnol F, Maggiori L et al (2009) Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula. Dis Colon Rectum 52(7):1290–1295CrossRefGoogle Scholar
  6. 6.
    Ulrich D, Roos J, Jakse G, Pallua N (2009) Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Reconstr Aesthet Surg 62(3):352–356CrossRefGoogle Scholar
  7. 7.
    Maeda Y, Heyckendorff-Diebold T, Tei TM, Lundby L, Buntzen S (2011) Gracilis muscle transposition for complex fistula and persistent nonhealing sinus in perianal Crohn’s disease. Inflamm Bowel Dis 17(2):583–589CrossRefGoogle Scholar
  8. 8.
    Zmora O, Potenti FM, Wexner SD et al (2003) Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg 237(4):483–487PubMedPubMedCentralGoogle Scholar
  9. 9.
    Wexner SD, Ruiz DE, Genua J et al (2008) Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg 248(1):39–43CrossRefGoogle Scholar
  10. 10.
    Fuerst A, Schmidbauer C, Justyna S-B et al (2008) Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease. Int J Colorectal Dis 23(4):349–353CrossRefGoogle Scholar
  11. 11.
    Fuerst A (2017) Gracilis transposition for repair of recurrent rectovaginal fistula. Coloproctology 39(2):84CrossRefGoogle Scholar
  12. 12.
    Borda Mederos LA, Chiroque Benites LI, Pinto Elera JO, Manzaneda Pineda AJ (2011) [Experience with a biological plug for biological in complex anal fistula]. Rev Gastroenterol Peru 31(4):345–350PubMedGoogle Scholar
  13. 13.
    Cintron JR, Abcarian H, Chaudhry V et al (2013) Treatment of fistula-in-ano using a porcine small intestinal submucosa anal fistula plug. Tech Coloproctol 17(2):187–191CrossRefGoogle Scholar
  14. 14.
    Kleif J, Hagen K, Wille-Jorgensen P (2011) Acceptable results using plug for the treatment of complex anal fistulas. Dan Med Bull 58(3):A4254PubMedGoogle Scholar
  15. 15.
    Schwandner T, Roblick MH, Kierer W et al (2009) Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum 52(9):1578–1583CrossRefGoogle Scholar
  16. 16.
    Schwandner O, Fuerst A, Kunstreich K, Scherer R (2009) Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 13(2):135–140CrossRefGoogle Scholar
  17. 17.
    Champagne BJ, O’Connor LM, Ferguson M et al (2006) Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum 49(12):1817–1821CrossRefGoogle Scholar
  18. 18.
    Chan S, McCullough J, Schizas A et al (2012) Initial experience of treating anal fistula with the Surgisis anal fistula plug. Tech Coloproctol 16(3):201–206CrossRefGoogle Scholar
  19. 19.
    El-Gazzaz G, Zutshi M, Hull T (2010) A retrospective review of chronic anal fistulae treated by anal fistulae plug. Colorectal Dis 12(5):442–447CrossRefGoogle Scholar
  20. 20.
    Lawes DA, Efron JE, Abbas M, Heppell J, Young-Fadok TM (2008) Early experience with the bioabsorbable anal fistula plug. World J Surg 32(6):1157–1159CrossRefGoogle Scholar
  21. 21.
    Panes J, Garcia-Olmo D, Van AG et al (2016) Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial. Lancet 388(10051):1281–1290CrossRefGoogle Scholar
  22. 22.
    Panes J, Rimola J (2017) Perianal fistulizing Crohn’s disease: pathogenesis, diagnosis and therapy. Nat Rev Gastroenterol Hepatol 14(11):652–664CrossRefGoogle Scholar
  23. 23.
    Panes J, Ordas I, Ricart E (2010) Stem cell treatment for Crohn’s disease. Expert Rev Clin Immunol 6(4):597–605CrossRefGoogle Scholar
  24. 24.
    Athanasiadis S, Oladeinde I, Kuprian A, Keller B (1995) Endorectal advancement flap-plasty vs. transperineal closure in surgical treatment of rectovaginal fistuls. A prospective long-term study of 88 patients. Chirurg 66(5):493–502PubMedGoogle Scholar
  25. 25.
    MacRae HM, McLeod RS, Cohen Z, Stern H, Reznick R (1995) Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 38(9):921–925CrossRefGoogle Scholar
  26. 26.
    Jones IT, Fazio VW, Jagelman DG (1987) The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 30(12):919–923CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryCaritas Clinic St. JosefRegensburgGermany

Personalised recommendations