title: Minimally invasive treatment of rectovaginal fistula.
abstract: BACKGROUND
  Rectovaginal fistulas (RVFs) are a rare surgical condition. Their treatment is extremely difficult, and no standard surgical technique is accepted worldwide. This report describes a new approach using transanal endoscopic microsurgery (TEM) to treat RVFs.
  
  
  METHODS
  A retrospective review of 13 patients who underwent repair of rectovaginal fistula using TEM between 2001 and 2008 was undertaken. The surgical technique is widely described, and the advantages of the endorectal approach are noted.
  
  
  RESULTS
  The median follow-up period was 25 months, and the median age of the patients was 44 years (range, 25-70 years). The mean operative time was 130 min (range, 90-150 min), and the hospital stay was 5 days (range, 3-8 days). One patient experienced recurrence. This patient underwent reoperation with TEM and experienced re-recurrence. Two patients had minor complications (hematoma of the septum and abscess of the septum), which were treated with medical therapy. For two patients, a moderate sphincter hypotonia was registered.
  
  
  CONCLUSIONS
  A new technique for treating RVFs using TEM is presented. The authors strongly recommend this approach that avoids any incision of the perineal area, which is very painful and can damage sphincter functions.
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation Paride Stefanini, University of Rome La Sapienza, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
authors.forename: Mario
authors.initials: M
authors.lastname: Guerrieri
authors.forename: Luciana
authors.initials: L
authors.lastname: Barchetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lezoche
authors.forename: Bernardina
authors.initials: B
authors.lastname: Fabiani
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
mesh_terms: D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000379:methods*; D051517:Digital Rectal Examination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011351:Proctoscopy / Q000379:methods*; D012006:Rectovaginal Fistula / Q000601:surgery*; D012189:Retrospective Studies
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