title: The long-term outcome of transvaginal anterior levatorplasty for intractable rectovaginal fistula.
abstract: OBJECTIVE
  Several procedures have been described for rectovaginal fistula with a wide range of success, but there is little information on the long-term outcome. The aim of the present study was to investigate the long-term outcome after transvaginal anterior levatorplasty (ALP) for intractable rectovaginal fistula.
  
  
  METHODS
  Data of 16 consecutive patients undergoing transvaginal ALP with fistulectomy and closure of the rectum and vagina between 1998 and 2011 were prospectively recorded and retrospectively investigated to study the long-term outcome.
  
  
  RESULTS
  Birth injury (n = 7), low anterior resection for rectal cancer (n = 3), pouch surgery for ulcerative colitis (n = 2) and a procedure for prolapse and haemorrhoids (n = 2) were the main causes of the fistula. Nine patients had a covering stoma before surgery. All patients underwent ALP, with a covering stoma in two patients. Infection occurred in one patient and wound rupture after surgery in another patient. These patients underwent reoperation by ALP. All fistulae had healed at a median follow-up of 84 (8-193) months after initial surgery or stoma closure.
  
  
  CONCLUSIONS
  Transvaginal ALP is effective for the treatment of mid or low rectovaginal fistula. The results show that a graft is not necessary regardless of whether or not previous surgery has been performed.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Koide
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hanai
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Masumori
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Katsuno
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina
keywords: Rectovaginal fistula; anterior levatorplasty; birth injury; fistula repair; low anterior resection