title: Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair.
abstract: BACKGROUND
  We investigated the correlation between operative procedures for rectal carcinoma and postoperative rectovaginal fistulas (RVF), and treatment for RVF.
  
  
  METHODS
  The medical records of 161 female patients with rectal carcinoma were examined retrospectively with respect to the cause, incidence, and methods of treatment for RVF occurring after rectal cancer operations, and to the outcomes of gluteal-fold flap repairs for RVF.
  
  
  RESULTS
  Of the 161 patients, 16 developed RVF clinically. The incidence of RVF was significantly higher in patients who were anastomosed by the double stapling technique (DST) and had concomitant resection of the vaginal wall. No statistical difference was found between the established diverting ostomy group and the no-stoma group. Six patients recovered by the establishment of a diverting ostomy only. The gluteal-fold flap technique was performed for 5 patients. No RVF recurrences were noted in these 5 patients.
  
  
  CONCLUSIONS
  The incidence of RVF was higher in the patients who were anastomosed by DST or had concomitant resection of the vaginal wall. Although some RVFs heal with only fecal diversion, for patients in whom RVF is caused by involvement of the vaginal wall in the circular staple or intersphincteric resection, good results are obtained with the gluteal-fold flap repair technique.
authors.affiliation: Divisions of Colorectal (Pelvic) Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. ckosugi0126@yahoo.co.jp
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kimata
authors.forename: Masato
authors.initials: M
authors.lastname: Ono
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugito
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.forename: Kazunori
authors.initials: K
authors.lastname: Sato
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D002081:Buttocks / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010030:Ostomy; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000453:epidemiology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome