title: Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas.
abstract: OBJECTIVE
  To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs).
  
  
  METHODS
  Between May 2009 and March 2012, 11 female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled. Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage. Efficacy was assessed in terms of the success rate and surgical complications. SF-36 quality of life (QOL) scores and Wexner fecal incontinence scores were compared before and after surgery.
  
  
  RESULTS
  The fistulas healed in 14 patients after gracilis muscle transposition; the initial healing rate was 73.7%. Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5 patients: 4 healed and 1 failed, and postoperative fecal diversions were performed for the patient whose treatment failed. At a median follow-up of 17 mo, the overall healing rate was 94.7%. Postoperative complications occurred in 4 cases. Significant improvement was observed in the quality outcomes framework scores (P < 0.001) and Wexner fecal incontinence scores (P = 0.002) after the successful healing of complex RVFs or RUFs. There was no significant difference in SF-36 QOL scores between the initial healing group and irrigation-suction-assisted healing group.
  
  
  CONCLUSIONS
  Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs. QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.
authors.affiliation: Xiao-Bing Chen, Dai-Xiang Liao, Jun-Hui Yu, Cheng-Hua Luo, Department of General and Colorectal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Xiao-Bing
authors.initials: XB
authors.lastname: Chen
authors.forename: You-Xin
authors.initials: YX
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: Dai-Xiang
authors.initials: DX
authors.lastname: Liao
authors.forename: Jun-Hui
authors.initials: JH
authors.lastname: Yu
authors.forename: Cheng-Hua
authors.initials: CH
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012003:Rectal Fistula / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D013396:Suction; D007507:Therapeutic Irrigation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014548:Urinary Fistula / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014624:Vaginal Fistula / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult
keywords: Gracilis muscle; Quality of life; Rectourethral fistula; Rectovaginal fistula; Therapeutic irrigation