TY - JOUR
T1 - Minimally invasive perineal redo surgery for rectovesical and rectovaginal fistulae
T2 - A case series
AU - Grüter, A. A. J.
AU - van Oostendorp, S. E.
AU - Smits, L. J. H.
AU - Kusters, M.
AU - Özer, M.
AU - Nieuwenhuijzen, J. A.
AU - Tuynman, J. B.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Introduction: Iatrogenic recto-urogenital fistulae are refractory complications that rarely heal without surgical intervention. The ongoing local infection causes pain, discomfort and substantially impacts quality of life. Surgical repair requires adequate exposure and space to fill with healthy tissue, which is a major challenge in pelvic redo surgery. An abdominal approach to repair the fistula is associated with major morbidity and often fails to expose the deep pelvis. In our experience a novel transperineal minimally invasive approach a utilizing single incision laparoscopic surgery (SILS) technique could offer improved results. Presentation of cases: In the present study, three cases of patients with recto-urogenital fistulae after pelvic surgery are described. Two patients were diagnosed with a rectovesical fistula and one patient with a rectovaginal fistula. In all three cases, a minimally invasive perineal approach, using a SILS port, was used to perform surgical repair. The closure of the fistulae involved: a separate repair of the urethra/bladder or vaginal defect and the rectal defect, followed by interposition of vascularized tissue by either a pudendal thigh fasciocutaneous flap or omentoplasty. Discussion and conclusion: This study is the first to report on a minimally invasive perineal approach, utilizing a SILS technique for recto-urogenital fistulae repair after previous pelvic surgery. The current approach improves exposure, creates surgical space, optimizes view and allows the interposition of vascularized tissue, without causing substantial blood loss and avoiding major abdominal surgery.
AB - Introduction: Iatrogenic recto-urogenital fistulae are refractory complications that rarely heal without surgical intervention. The ongoing local infection causes pain, discomfort and substantially impacts quality of life. Surgical repair requires adequate exposure and space to fill with healthy tissue, which is a major challenge in pelvic redo surgery. An abdominal approach to repair the fistula is associated with major morbidity and often fails to expose the deep pelvis. In our experience a novel transperineal minimally invasive approach a utilizing single incision laparoscopic surgery (SILS) technique could offer improved results. Presentation of cases: In the present study, three cases of patients with recto-urogenital fistulae after pelvic surgery are described. Two patients were diagnosed with a rectovesical fistula and one patient with a rectovaginal fistula. In all three cases, a minimally invasive perineal approach, using a SILS port, was used to perform surgical repair. The closure of the fistulae involved: a separate repair of the urethra/bladder or vaginal defect and the rectal defect, followed by interposition of vascularized tissue by either a pudendal thigh fasciocutaneous flap or omentoplasty. Discussion and conclusion: This study is the first to report on a minimally invasive perineal approach, utilizing a SILS technique for recto-urogenital fistulae repair after previous pelvic surgery. The current approach improves exposure, creates surgical space, optimizes view and allows the interposition of vascularized tissue, without causing substantial blood loss and avoiding major abdominal surgery.
KW - Case series
KW - Minimally invasive
KW - Perineal redo surgery
KW - Rectovaginal fistula
KW - Rectovesical fistula
KW - SILS
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85097405510&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33395885
UR - http://www.scopus.com/inward/record.url?scp=85097405510&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijscr.2020.11.067
DO - https://doi.org/10.1016/j.ijscr.2020.11.067
M3 - Article
C2 - 33395885
SN - 2210-2612
VL - 77
SP - 733
EP - 738
JO - International journal of surgery case reports
JF - International journal of surgery case reports
ER -