title: Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition.
abstract: BACKGROUND
  Rectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures.
  
  
  METHODS
  We report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures.
  
  
  CONCLUSIONS
  This technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum.
  
  
  CONCLUSIONS
  In our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair.
authors.affiliation: Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy. Electronic address: patagiacomo@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.affiliation: Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pasini
authors.affiliation: Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Roncali
authors.affiliation: Department of Medical & Surgical Sciences, 2nd Division of General Surgery, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Tognali
authors.affiliation: Department of Medical & Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ragni
keywords: Pubo-coccygeus muscle; Rectovaginal fistula repair; STARR; TRANSTAR