대한대장항문학회

Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or<br>previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal<br>Hospital. The mean age was 36.9 (range, 25∼56) years. The mean follow-up after operation<br>was 33 (range, 8∼62) months. The etiology of the fistula in the majority of patients was<br>obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at<br>repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a<br>3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body<br>reconstruction or sphincter repair. Two patients were managed with a mucosal flap<br>advancement only without a repair of rectovaginal septum. In all cases, a concomitant<br>colostomy was not performed. Postoperative complications were noticed in 3 of the patients<br>managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with<br>perineal body reconstruction or sphincter repair and all were perineal wound infections. All<br>of these infections were cured, without recurrence, by simple rubber seton drainage.<br>Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with<br>liquid incontinence became continent after a sphincter reconstruction. We conclude that most<br>rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed<br>with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs<br>or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during<br>manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should<br>be performed.<br>