This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Transvaginal repair of pouch–vaginal fistula. BJS 2001; 88: 241-245.
Published: 6th December 2002
Authors: D. Burke, C. J. H. M. van Laarhoven, F. Herbst, R. J. Nicholls
Background
The results of surgery for ileoanal pouch–vaginal fistula have been disappointing. Intra‐anal procedures result in fistula healing in, at best, approximately 50 per cent of patients. A transvaginal approach was developed to achieve direct access to the internal opening, enabling closure without damage to the anal sphincter.
Method
Fourteen patients were treated between January 1992 and December 1998. All had had restorative proctocolectomy for ulcerative colitis and all were defunctioned. Histological review confirmed the diagnosis in all patients.
Results
Median age was 40 (range 25–52) years. Median follow‐up was 18 (range 6–60) months. The operation was successful in 11 of the 14 patients, after one attempt in six patients, after two attempts in four, and after three attempts in one patient. The operation failed in three patients, who had a permanent ileostomy. The number of bowel actions in the patients who had successful closure ranged from 2 to 10 (median 6) in 24 h, with no faecal incontinence reported.
Conclusion
This simple technique achieved healing in 11 of 14 patients. This compares favourably with the poor results in 28 patients treated by other procedures in the same hospital, with certain healing in five and definite failure in 20. © 2001 British Journal of Surgery Society Ltd
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