Surgical Repair of Rectovaginal Fistula after Low Anterior Resection Using Gracilis Muscular Flap: A Case Report

Masaomi Mizutani, Akira Fuse, Takatoshi Makino, Toshiyuki Moriya, Akihiko Suzuki, Hideki Isobe, Masahiro Kamiga and Wataru Kimura

Department of Gastroenterol and General Surgery, Yamagata University School of Medicine

A 63-year-old woman undergoing low anterior resection (LAR) for rectal carcinoma suffered fecal discharge appeared from the vagina starting on 4 postoperative day (POD). Transvaginal fistulectomy, endoscopic fistula closure, and transverse colostomy were not effective. We took a perineal approach using a gracilis muscular flap. After resection of posterior wall of the vagina including the fistula, the defect on wall of the rectum was closed, and the flap anchored on the anterior wall of the rectum. The postoperative course was functionally and cosmetically uneventful. Half of a year later, the transverse colostomy was closed. She now reports no problems. Results thus verified the functional and cosmetic usefulness of the approach using the gracilis muscular flap in rectovaginal fistula after LAR.

Key words
rectovaginal fistula, low anterior resection, gracilis muscular flap

Reprint requests
Masaomi Mizutani Department of Gastroenterol and General Surgery, Yamagata University School of Medicine
2-2-2 Iidanishi, Yamagata city, 990-9585 JAPAN

Accepted
July 28, 2004

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