Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 28, 2010; 16(24): 3011-3015
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3011
Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse
Mehdi Ouaïssi, Silvia Cresti, Urs Giger, Igor Sielezneff, Nicolas Pirrò, Bruno Berthet, Philippe Grandval, Bernard Consentino, Bernard Sastre
Mehdi Ouaïssi, Silvia Cresti, Igor Sielezneff, Nicolas Pirrò, Bruno Berthet, Bernard Consentino, Bernard Sastre, Department of Visceral- and Oncological Surgery, Timone Hospital, 13385 Marseille, France
Urs Giger, Department of Surgery, Kantonsspital Bruderholz, 4101 Binningen, Switzerland
Philippe Grandval, Department of gastroenterology, Timone Hospital, 13385 Marseille, France
Author contributions: Ouaïssi M and Cresti S contributed equally; Cresti S, Ouaïssi M and Giger U conceived and designed the study; Cresti S and Ouaïssi M performed the acquisition, analysis, and interpretation of data; Ouaïssi M and Giger U drafted the manuscript; Sastre B, Sielezneff I, Pirrò N, Consentino B, Berthet B and Grandval P reviewed and supervised the manuscript.
Supported by The Assistance publique des Hôpitaux de Marseille et Université de la Méditerranée Aix Marseille II (faculté de médecine)
Correspondence to: Mehdi Ouaïssi, MD, PhD, Department of Visceral- and Oncological Surgery, Timone Hospital, 13385 Marseille, Cedex 05, France.
Telephone: +33-491-385852 Fax: +33-491-385552
Received: February 26, 2010
Revised: March 30, 2010
Accepted: April 6, 2010
Published online: June 28, 2010

AIM: To communicate our findings on successful treatment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP).

METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with prosthetic reinforcement.

RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptoms were reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anastomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.

CONCLUSION: In our experience, the definitive treatment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

Keywords: Pelvic organ prolapse, Recto-vaginal fistula, Prosthetic treatment