title: The Outcomes of Ultralow Anterior Resection or an Abdominoperineal Pull-Through Resection and Coloanal Anastomosis for Radiation-Induced Recto-Vaginal Fistula Patients.
abstract: The purpose of this study was to evaluate the outcomes of patients who underwent colorectal resections and coloanal anastomosis for radiation-induced recto-vaginal fistulas (RVFs). The effect of the surgical treatment technique on bowel function, fecal continence, and quality of life of patients was also evaluated.
  
  
  
  Twenty-one female patients, who received adjuvant chemotherapy and external beam pelvic radiation for cervix carcinoma after radical hysterectomy + pelvic/paraaortic lymph node dissection, having RVF but without tumor recurrence, were included. All patients underwent an ultralow anterior resection (n = 11) or an abdominoperineal pull-through resection and straight coloanal anastomosis (n = 10). A bowel functions questionnaire and a Fecal Incontinence Quality of Life (FIQLI) questionnaire were applied to patients pre-operatively and also 6 months after the ileostomy closure procedures.
  
  
  
  No recurrent RVF was observed in a mean follow-up period of 20 months after ostomy reversal procedures. The FIQLI depression, lifestyle, and embarrassment scores were significantly improved on the follow-up questionnaire. The mean pre- and post-operative incontinence scores were not significantly different.
  
  
  
  The spontaneous closure rate after a simple diverting stoma is quite low and local repair procedures usually result in failure. In selected patients, performing a nearly total rectum resection and maintaining the intestinal continuity with a coloanal anastomosis may be accepted as a safe and curative option. Recurrence-free outcome and the improvement of the quality of life of the patients represent the efficiency of this treatment modality.
authors.affiliation: School of Medicine, Department of General Surgery, Baskent University Hospital, Istanbul, Turkey. fezaykar@yahoo.com.
authors.forename: Feza Yarbug
authors.initials: FY
authors.lastname: Karakayali
authors.affiliation: School of Medicine, Department of General Surgery, Baskent University, Ankara, Turkey.
authors.forename: Tugan
authors.initials: T
authors.lastname: Tezcaner
authors.affiliation: School of Medicine, Department of General Surgery, Baskent University Hospital, Istanbul, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Ozcelik
authors.affiliation: School of Medicine, Department of General Surgery, Baskent University, Ankara, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Moray
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D011788:Quality of Life; D011832:Radiation Injuries / Q000150:complications*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery
keywords: Abdominoperineal pull-through resection and coloanal anastomosis; Radiotherapy; Recto-vaginal fistula; Ultralow anterior resection