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. 2010 Jun 28;16(24):3011-5.
doi: 10.3748/wjg.v16.i24.3011.

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

Mehdi Ouaïssi  1 , Silvia Cresti, Urs Giger, Igor Sielezneff, Nicolas Pirrò, Bruno Berthet, Philippe Grandval, Bernard Consentino, Bernard Sastre
Affiliations

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

Mehdi Ouaïssi et al. World J Gastroenterol. .

Abstract

Aim: To communicate our findings on successful treatment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP).

Methods: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with prosthetic reinforcement.

Results: All patients complained about ongoing vaginal infections and febrile episodes. These symptoms were reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anastomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.

Conclusion: In our experience, the definitive treatment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

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Figures

Figure 1
Figure 1
Pelvic magnetic resonance imaging (MRI) showing a transverse section of patient No. 3 with a complex recto-vaginal fistula (RVF) and destruction of the anal sphincter complex. The black arrows show a collection of 8.1 mm with complete destruction of the anal sphincter.
Figure 2
Figure 2
Colonoscopy. Recto-vaginal fistula (arrow) due to polypropylene mesh erosion and migration into the rectum.
See this image and copyright information in PMC

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