Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula.
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.
Lefèvre
J H
JH
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital (AP-HP), Clichy, France.
Bretagnol
F
F
Maggiori
L
L
Alves
A
A
Ferron
M
M
Panis
Y
Y
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