title: Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn's disease.
abstract: OBJECTIVE
  Local surgical procedures in the presence of Crohn's disease have a markedly reduced success rate, especially in the treatment of recurrent anovaginal and distant rectovaginal fistulas. In these patients, local surgery (e.g., flap closure) has unsatisfactory results if the anal canal is destroyed by ulceration and indurations or in patients with extensive defects of the perineum.
  
  
  METHODS
  Over a period of 6 years (2000 to 2006), 12 patients with recurrent rectovaginal fistulas were treated with graciloplasty. The age of the female patients ranged from 24 to 47 years, the mean age being 38 years. The presence of Crohn's disease in all patients had a mean duration of 12 years. Corticosteroids, mesalazin, or azathioprin were administered preoperatively. All patients were diverted by a temporary ileostomy before graciloplasty. RESULTS Rectovaginal fistula was closed in 11 of 12 patients after graciloplasty with a mean follow-up of 3.4 years. One rerecurrence of a rectovaginal fistula was documented. One of 12 ileostomies was not closed due to persistence of the fistula tract. One patient had a pouch-anal and, additionally, a pouch-vaginal fistula. In this patient, the first transposition of the gracilis muscle was unsuccessful. After a few months, she underwent renewed graciloplasty. There was no recurrence of a fistula within the follow-up period. Reconstruction of the perineum constituted an additional positive effect of the graciloplasty. In one patient, the preexisting fecal incontinence persisted, even after secondary implantation of a pacemaker. Due to diarrhea and persistent fecal incontinence, the patient opted for a renewed ileostomy.
  
  
  CONCLUSIONS
  In our series, gracilis transposition in the treatment of recurrent anovaginal and rectovaginal fistulas in patients with Crohn's disease has excellent short-term results. In addition, graciloplasty can reconstruct the perineal defect.
authors: Department of Surgery, Caritas-Clinic St. Josef, Landshuterstr. 65, 93053 Regensburg, Germany. fuerst@caritasstjosef.de
authors: Alois
authors: A
authors: Fürst
authors: Christin
authors: C
authors: Schmidbauer
authors: Justyna
authors: J
authors: Swol-Ben
authors: Igors
authors: I
authors: Iesalnieks
authors: Oliver
authors: O
authors: Schwandner
authors: Ayman
authors: A
authors: Agha
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome