title: Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty.
abstract: OBJECTIVE
  This study evaluated the effectiveness of combining advancement flap with sphincteroplasty in patients symptomatic with rectovaginal fistula and anal sphincter disruption.
  
  
  METHODS
  Twenty patients with rectovaginal fistulas and anal sphincter disruptions after vaginal deliveries underwent combined rectal mucosal advancement flap and anal sphincteroplasty between July 1986 and July 1993. The mean age of the patients was 30 (range, 18-40) years and the mean duration of symptoms was 54.8 weeks (range, 7 weeks to 6 years). In addition to mucosal advancement flap repair, 13 patients underwent two-layer repair of anal sphincters (with reapproximation of the puborectalis in 8 of the patients); 6 patients underwent one-layer overlap repair of anal sphincters (with reapproximation of the puborectalis in 2 of the patients); and 1 patient underwent reapproximation of internal anal sphincter alone because squeeze pressures were adequate, as determined by anal manometry.
  
  
  RESULTS
  Postoperatively, vaginal discharge of stool and flatus was eliminated entirely in all 20 patients. Perfect anal continence of stool and flatus was restored in 14 patients (70 percent). Incontinence was improved but not eliminated in six patients (4 incontinent to liquid stool and 2 to flatus), and two patients required perineal pads. Subjectively, 19 patients (95 percent) reported the result as excellent or good. There were no complications.
  
  
  CONCLUSIONS
  The combination of mucosal advancement flap and anal sphincteroplasty is a safe and highly effective procedure for correcting rectovaginal fistula with sphincter disruption after obstetrical injuries.
authors.affiliation: Division of Colon and Rectal Surgery, Mount Carmel Health System, Columbus, Ohio, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Khanduja
authors.forename: A
authors.initials: A
authors.lastname: Padmanabhan
authors.forename: B A
authors.initials: BA
authors.lastname: Kerner
authors.forename: W E
authors.initials: WE
authors.lastname: Wise
authors.forename: P S
authors.initials: PS
authors.lastname: Aguilar
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004576:Electromyography; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000601:surgery*; D008365:Manometry; D011312:Pressure; D012006:Rectovaginal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D019522:Vaginal Discharge / Q000209:etiology / Q000601:surgery