title: Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients.
abstract: BACKGROUND
  The aim of this study was to review our experience with gracilis muscle interposition for complex perineal fistulas.
  
  
  METHODS
  A retrospective review of all patients who underwent repair of perineal fistula using the gracilis muscle between 1995 and 2007 was undertaken. Patients were divided into 2 groups according to the fistula type by gender: females (rectovaginal and pouch-vaginal) and males (rectourethral).
  
  
  RESULTS
  Gracilis interposition was performed in 53 patients. Seventeen women underwent 19 gracilis interpositions for 15 rectovaginal and 2 pouch-vaginal fistulas; 76% had a mean of (1-4) (mean of 2) prior failed attempt at repair. Eight patients experienced at least one postoperative complication. Two women required a second gracilis interposition. Thirty-three percent of the Crohn's disease-associated fistulas successfully healed; 75% without Crohn's successfully healed.Thirty-six males underwent gracilis interposition for rectourethral fistulas, mainly due to prostate cancer treatment; 13 (36%) had a mean of 1.5 (range 1-3) failed prior repairs. Seventeen patients experienced postoperative complications. The initial success rate in men with rectourethral fistulas was 78%. After successful second procedures in 8 patients, the overall clinical healing rate was 97%.
  
  
  CONCLUSIONS
  The gracilis muscle transposition is a safe and effective method of treating complex perianal fistulas.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA. deanh@ccf.org
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Dan E
authors.initials: DE
authors.lastname: Ruiz
authors.forename: Jill
authors.initials: J
authors.lastname: Genua
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: Eric G
authors.initials: EG
authors.lastname: Weiss
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003424:Crohn Disease / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery*