대한대장항문학회

Twenty women with rectovaginal fistula were treated during 10 years from 1979 to<br>1991 at Department of General Surgery, National Medical Center.<br>The etiology of the fistula in the majority was obstetric(birth injury) in 12 cases, and<br>other causes such as radiotherapy for pelvic malignancies, sclerotherapy for hemorrhoids,<br>pelvic or perineal operations and direct perineal trauma(stab injury, traffic accident) were<br>in 2 cases each. Third and fourth decades were involved commonly in 7 cases each.<br>Anal incontinence was associated in 13 cases and it occurred mainly in obstetric<br>causes(10/12) and direct perineal trauma(2/2). Fleshman grade Ⅳ incontinence was<br>common in 6 cases(6/12). Main type was simple in 17 cases, low in 15 cases and<br>Rosenshein type Ⅲ in 9 cases. Eighteen cases were managed by operation methods such<br>as local repair method i.e. transperineal excision of fistula with layer closure in 8 cases,<br>conversion to complete perineal laceration with layer closure method in 6 cases,<br>transvaginal repair(inversion of fistula) in 2 cases and colostomy in 2 cases but 2 cases<br>were managed conservatively. Clinical improvements were achieved in obstetric causes<br>(10/l2) and direct perineal trauma(2/2) by means of transperineal<br>approach(6/8),<br>conversion method(5/6) and transvaginal approach(2/2). Favourable changes were<br>acquired in a viewpoint of incontinence in all cases with anal incontinence(13/13).<br>Thus we concluded as follows. Main causes of rectovaginal fistulae were obstetric<br>injury and for the best results it would be managed by local repair methods and most<br>excellent method for obstetric causes was conversion method.<br>Anal incontinence was associated commonly with obstetric causes and direct perineal<br>trauma, so plication sphincteroplasty were combined with operation method in all cases<br>and they were effective in improvement of anal incontinence.<br>