Background
Treatment of complex and recurrent rectovaginal fistulas (RVF) is a challenge, with
high recurrence rates. Gracilis muscle transposition (GMT) is an option for
management of such cases. The aim of this study was to evaluate the outcome
of GMT in management of patients with recurrent or complex RVF and the effect of
this procedure on the quality of life (QoL) and the sexual function.
Patients and methods
The current study included 23 female patients presented with recurrent and
complex RVF who were eligible to undergo GMT. Early postoperative
complications were reported. Follow-up was extended up to 24 months to detect
recurrence. QoL and sexual function were evaluated using Colorectal-Anal Impact
Questionnaire-7 scale from Pelvic Floor Impact Questionnaire-short form 7 and the
Female Sexual Function Index, respectively.
Result
The mean age of the included patients was 43.6±10.16 years. Early postoperative
follow-up reported surgical site infection and functional lower limb problem in 13%,
and hematoma, deep vein thrombosis, and hypoesthesia in only 4% of cases for
each. Recurrence was reported in 21.5% of cases, with fistula-free time of 7.6±2.3
months. There was a statistically significant difference in Female Sexual Function
Index in patients with preoperative sexual problem (P=0.001) and in Colorectal-
Anal Impact Questionnaire-7 scale before and after graciloplasty (P=0.0001).
Conclusion
GMT is assumed to be an optimal option for recurrent and complex RVFs, with
minimal postoperative complications and high success rates. Patients who
underwent GMT showed significant improvement of the female sexual function
and the overall QoL. |
