Brief Article
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World J Gastroenterol. Oct 21, 2013; 19(39): 6625-6629
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6625
Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas
Xiao-Bing Chen, You-Xin Wang, Hua Jiang, Dai-Xiang Liao, Jun-Hui Yu, Cheng-Hua Luo
Xiao-Bing Chen, Dai-Xiang Liao, Jun-Hui Yu, Cheng-Hua Luo, Department of General and Colorectal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
You-Xin Wang, Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China
Hua Jiang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Chen XB and Wang YX contributed equally to this work; Luo CH and Liao DX designed research; Wang YX and Chen XB analyzed data; Luo CH, Wang YX and Chen XB drafted the paper; Chen XB, Liao DX, Jiang H and Yu JH performed patients’ enrollment, the measurement, and the follow-up and collection of the data.
Supported by National Natural Science Foundation of China, No. 81372586
Correspondence to: Cheng-Hua Luo, PhD, MD, Professor, Department of General and Colorectal Surgery, Beijing Shijitan Hospital, Capital Medical University. No. 10 Tieyi Road, Beijing 100038, China. luoch.md@gmail.com
Telephone: +86-10-63926525 Fax: +86-10-63925588
Received: July 23, 2013
Revised: September 25, 2013
Accepted: September 29, 2013
Published online: October 21, 2013
Processing time: 107 Days and 17.9 Hours
Abstract

AIM: To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs).

METHODS: Between May 2009 and March 2012, 11 female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled. Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage. Efficacy was assessed in terms of the success rate and surgical complications. SF-36 quality of life (QOL) scores and Wexner fecal incontinence scores were compared before and after surgery.

RESULTS: The fistulas healed in 14 patients after gracilis muscle transposition; the initial healing rate was 73.7%. Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5 patients: 4 healed and 1 failed, and postoperative fecal diversions were performed for the patient whose treatment failed. At a median follow-up of 17 mo, the overall healing rate was 94.7%. Postoperative complications occurred in 4 cases. Significant improvement was observed in the quality outcomes framework scores (P < 0.001) and Wexner fecal incontinence scores (P = 0.002) after the successful healing of complex RVFs or RUFs. There was no significant difference in SF-36 QOL scores between the initial healing group and irrigation-suction-assisted healing group.

CONCLUSION: Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs. QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.

Keywords: Rectovaginal fistula; Rectourethral fistula; Gracilis muscle; Quality of life; Therapeutic irrigation

Core tip: A prospective study of 19 patients with complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs) undergoing gracilis muscle transposition followed by postoperative salvage wound irrigation-suction was reported to yield an overall healing rate of 94.7%. In addition, quality of life and fecal incontinence were reported to be significantly improved after the successful healing of RVFs and RUFs.