TEMS: an alternative method for the repair of benign recto-vaginal fistulae.
METHODS
The repair of high recto-vaginal fistula can be challenging since access may be limited via the endo-anal approach yet the alternative trans-abdominal route carries significant morbidity. We report the use of TEMS to repair a recto-vaginal fistula following anterior resection and pelvic radiotherapy.


METHODS
The patient was placed prone and a 25 cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. COMPARISON WITH OTHER TECHNIQUES: TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo-anal or trans-vaginal techniques. The morbidity is lower than the trans-abdominal route.


CONCLUSIONS
TEMS is a useful technique for the repair of benign recto-vaginal fistula and has distinct advantages over conventional techniques.
Darwood
R J
RJ
Department of Gastro-intestinal Surgery, Cheltenham General Hospital, Cheltenham, UK. rosie_darwood@btinternet.com
Borley
N R
NR
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001003:Anal Canal; D004724:Endoscopy; D005260:Female; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery; D012006:Rectovaginal Fistula / Q000601:surgery*