Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse.
OBJECTIVE
To communicate our findings on successful treatment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP).


METHODS
A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with prosthetic reinforcement.


RESULTS
All patients complained about ongoing vaginal infections and febrile episodes. These symptoms were reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anastomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.


CONCLUSIONS
In our experience, the definitive treatment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.
Ouaïssi
Mehdi
M
Department of Visceral- and Oncological Surgery, Timone Hospital, 13385 Marseille, France. mehdi.ouaissi@mail.ap-hm.fr
Cresti
Silvia
S
Giger
Urs
U
Sielezneff
Igor
I
Pirrò
Nicolas
N
Berthet
Bruno
B
Grandval
Philippe
P
Consentino
Bernard
B
Sastre
Bernard
B
D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D019736:Prostheses and Implants; D012006:Rectovaginal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome