title: Gracilis muscle transposition for fistulas between the rectum and urethra or vagina.
abstract: OBJECTIVE
  This study was designed to assess the efficacy of gracilis muscle transposition in repairing rectovaginal and rectourethral fistulas.
  
  
  METHODS
  Data were retrieved from a retrospective chart review of patients who underwent gracilis muscle transposition for fistulas between the rectum and urethra/vagina. All patients had fecal diversion as a preliminary or concurrent step to fistula repair. Follow-up data were gathered from outpatient clinic visits. Success was defined as a healed fistula after stoma closure.
  
  
  RESULTS
  Six females and three males, aged 30 to 64 years, underwent gracilis muscle transpositions from 1999 to 2005. One pouch-vaginal, three rectourethral, and five rectovaginal fistulas were repaired. The etiologies were Crohn's disease (n = 2), iatrogenic injury to the rectum during radical prostatectomy (n = 2), previous pelvic irradiation for rectal cancer (n = 2) or for cervical cancer (n = 1), recurrent perianal abscesses with fistulas (n = 1), and obstetric tear (n = 1). Seven patients underwent previous medical and surgical repair attempts. There were no intraoperative complications. Postoperative complications included perineal wound infection (n = 1) and at the colostomy closure (n = 2). There were no long-term sequelae. At a median follow-up period of 14 (range, 1-66) months since stoma closure, the fistula healed in seven patients. One patient refused ileostomy closure. One patient with severe Crohn's proctitis has a persistent rectovaginal fistula.
  
  
  CONCLUSIONS
  Gracilis muscle transposition is a viable option for repairing fistulas between the urethra, vagina, and the rectum, especially after failed perineal or transanal repairs. It is associated with low morbidity and a good success rate. Underlying Crohn's disease and previous radiation are associated with poor prognosis.
authors.affiliation: Colorectal Unit, Division of Surgery B, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Zmora
authors.forename: Hagit
authors.initials: H
authors.lastname: Tulchinsky
authors.forename: Eyal
authors.initials: E
authors.lastname: Gur
authors.forename: Gideon
authors.initials: G
authors.lastname: Goldman
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
authors.forename: Micha
authors.initials: M
authors.lastname: Rabau
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000601:surgery*; D013524:Surgical Flaps; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*