title: Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula.
abstract: OBJECTIVE
  The aim of this study was to assess the efficacy of gracilis muscle transposition for recurrent rectovaginal fistula.
  
  
  METHODS
  Gracilis muscle transposition for recurrent rectovaginal fistula was performed in eight patients. Causes of fistulas included Crohn's disease (n = 5), perineal surgery (n = 2), and obstetrical injury (n = 1). All patients underwent a mean of three (range, 1-6) previous repairs. Fecal diversion was performed in all cases.
  
  
  RESULTS
  Six of eight patients (75%) healed after gracilis muscle transposition alone. The other two patients required a second gracilis. These two patients failed with another recurrence and one of them underwent laparotomy with successful omental interposition. Thus, after a median follow-up of 28 (range, 4-55) months, the per-gracilis muscle transposition healing rate was 60% (6/10) and the overall healing success rate after gracilis muscle transposition and other procedures was 88% (7/8). For patients with Crohn's disease, four of five (80%) presented no recurrent rectovaginal fistula. Seven of eight patients underwent ileostomy closure after gracilis, but two required subsequent stomas, one for a late recurrence. Overall, five of eight patients are stoma-free. Despite healing, postoperative quality of life and sexual activity remained significantly altered.
  
  
  CONCLUSIONS
  Gracilis muscle transposition can be proposed in cases of recurrent rectovaginal fistula. The procedure has a good success rate, especially in Crohn's disease patients.
authors: Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital (AP-HP), Clichy, France.
authors: J H
authors: JH
authors: Lefèvre
authors: F
authors: F
authors: Bretagnol
authors: L
authors: L
authors: Maggiori
authors: A
authors: A
authors: Alves
authors: M
authors: M
authors: Ferron
authors: Y
authors: Y
authors: Panis
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007081:Ileostomy; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function; D012006:Rectovaginal Fistula / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012725:Sexual Behavior; D013524:Surgical Flaps; D013848:Thigh; D016896:Treatment Outcome