Authors : Pradeep Kumar Singh, Manoj Kumar Johar, Vishal Kumar Biswkarma
DOI : 10.18231/j.ijogr.2019.113
Volume : 6
Issue : 4
Year : 2019
Page No : 527-531
Introduction: Rectovaginal fistulas represent an often devastating condition in patients and a challenge for
surgeons. Successful management of this condition must take into account a variety of variables including
the etiology, size, and location of the fistula. We retrospectively evaluated our experience with the gracilis
interposition procedure to assess its efficacy in repairing rectovaginal fistulas.
Materials and Methods: We performed a retrospective study of all patients who underwent gracillis
muscle interposition flap in our institution from January 2015 to November 2018 for the repair of fistulas
between the rectum and vagina arising from diverse etiologies.
Results: Rectovaginal fistula repair with gracilis muscle interposition was done in twelve patients. The
etiologies were obstetric trauma (n=7), trauma (n=3), post arteriovenous malformation excision (n=1) and
one patient had fistula after excision of squamous papilloma of rectum. Overall all the patients with gracilis
interposition flap resulted in complete healing, a success rate of 100 percent.
Discussion: Various surgical procedures have been suggested for the repair of these fistulas, including fecal
diversion, primary repair, endorectal advancement flap, transvaginal repair, coloanal sleeve anastomosis,
and interposition flaps. The reported success rate for the repair of rectovaginal or rectourethral fistulas
using the gracilis muscle interposition technique is generally much higher than that reported for other
repair techniques.
Conclusion: Given the high success rate and low complication rate, repair with gracilis muscle
interposition is recommended for fistulas with unfavorable local conditions, such as those present after
radiation or subsequent to long-term, persistent infection, and especially after failed previous repairs.
Keywords: Rectovaginal fistula, Gracilis muscle, Interposition.