대한대장항문학회

<b>Purpose:</b> Generally speaking, permanent colostomy has been frequently used as a treatment for radiation-induced rectovaginal fistula. In order to administer an operation accurately, at least two-staged operations have been performed. If<br>anastomosis were to be performed between normal, healthy tissues after removal of irradiation-damaged tissues definite operation could be performed in one stage. We reviewed clinical records to evaluate postoperative recurrence and anal functions<br>in<br>patients who underwent coloanal anastomosis without diverting colostomy as one step due to radiation-induced rectovaginal fistula.<br><br><b>Method:</b> From Sep. 1994 to Jun. 2000 we did a retrospective study with clinical data of 8 patients who underwent operations due to radiation-induced rectovaginal fistula in Yongdong Severance Hospital.<br><br><b>Results:</b> The mean age was 49 years (range 31∼61). All patients concurrently received irradiation and induction chemotherapy due to primary, gynecologic malignancies. The total dosage of exposure to radiation was 8,400 c㏉ in 6 of 8 cases<br>and<br>8,940 c㏉ in the remaining 2 cases. TAH with BSO had been undergone before concurrent chemoradiation in 2 cases. The median duration from diagnosis to operation was 29 months (range 16∼131) in cases without previous colostomy (n=7) and 7 months<br>in<br>cases with colostom y (n=1). Before the operation, previous surgery had been undergone in 2 cases due to rectovaginal fistula. No recurrences were noted for gynecologic malignancies. The mean distance of fistula opening from anal verge was 3.9 ㎝<br>(range<br>2.0∼7.0). For 7 out of 8 cases, patients underwent LAR with handsewn coloanal anstomosis and the remaining patient underwent anterior resection. No diverting colostomy was performed for all cases. During the median follow-up period of 25 months<br>(range<br>7∼71), two patients developed anal stenosis. One patient experienced postoperative recurrence for the follow-up period. In terms of sphincter function (n=6) (f/μ period＞12 months), there were 1 urgency, 1 gas incontinence and 1 night<br>staining.<br><br><b>Conclusions:</b> Although this study is a small scale research in terms of the number of subjects involved, one-staged, handsewn coloanal anastomosis after LAR without colostomy may be proved to be helpful for the patients with<br>radiation-induced<br>rectovaginal fistula. If case selection performed properly, unnecessary operation can be avoided and psychologic resistance can be reduced by this procedure.<br>