ESPECTRO CLINICO DE LA FISTULA RECTOVAGINAL: ANALISIS DE 38 PACIENTES

Abstract

A retrospective analysis of surgical treatment in 38 patients with recto-vaginal fistula (RVF) in a twelve years period is being presented. Is defined as a simple RVF when is low, less than 2.5 cm and traumatic or infections in origin, and as a complex are if it is high, larger than 2.5 cm and of neoplastic, actinic or inflammatory origin. The most common etiology was neoplastic, 39% (15/38): due to persistence of cervical cancer in 10 patients, treated with radiotherapy, surgery or both; rectal carcinoma in 3 patients and anal cancer in 2. Two patients with rectal carcinoma were treated with radical surgery and sphincter conservation in one of them and posterior exenteration on the other, they survival free of disease to and 60 months respectively. Both cases with anal cancer were managed with posterior exenteration because tumoral persistence after receiving radio and chemotherapy by the nigro scheme. Actinic RVF were present in 34% (13/38); twelve of them were treated by the Parks operation (coloanal anastomosis and rectal mucosectomy), successful in all of them, although 40% had some kind of continence disturbance. Four patients with RVF (11%) were consequence of pelvic surgery complications, three of them closed only after a diverting procedure. Obstetrical RVF (16%) were repared by a local procedure using a thick rectal flap and simultaneous sphincter repair always with good results. In cases of cervical cancer with tumoral remnants, a diverting loop sigmoidostomy was sufficient in most of them and some of them with 26 months survival. In this series, 84% are complex RVF and 50% of them were submitted to abdominal radical surgery with no need of a permanent ostomy. Series of RVF are heterogeneous in composition due diferences in etiology of each group making difficult comparative studies.