Name of the Procedure:

Closure of rectovaginal fistula; vaginal or transanal approach

Summary

A surgical procedure to repair a rectovaginal fistula, which is an abnormal connection between the rectum and vagina. This can be done through the vaginal or anal route to close the fistula and restore normal function.

Purpose

This procedure addresses a rectovaginal fistula—a condition where there is an abnormal passageway between the rectum and vagina. The goal is to close this passage, thereby stopping the inappropriate flow of stool or gas into the vagina and restoring normal anatomy.

Indications

• Persistent or recurrent infections
• Fecal incontinence or passage of stool through the vagina
• Pain or discomfort in the pelvic area
• Previous failed attempts at fistula closure

Preparation

• Fasting for a certain period before the surgery (usually 8 hours)
• Adjusting or stopping certain medications as advised by the healthcare provider
• Undergoing preoperative tests like blood work and imaging studies
• Bowel preparation, which may include laxatives or enemas to clear the colon

Procedure Description

1. The patient is placed under anesthesia.
2. A surgical incision is made either through the vagina or the anus, based on the chosen approach.
3. The fistula tract is identified and carefully dissected.
4. The fistula opening is then closed using sutures, sometimes reinforced with tissue from nearby areas.
5. The surgical site is inspected for any potential issues and then closed.

Tools used may include surgical scissors, sutures, retractors, and possibly tissue reinforcement grafts. General or regional anesthesia is typically used.

Duration

The procedure usually takes between 1 to 2 hours.

Setting

This procedure is performed in a hospital setting, often in an operating room equipped for surgical procedures.

Personnel

• Surgeons (colorectal or gynecological surgeons)
• Nurses
• Anesthesiologists
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Pain or discomfort
• Recurrence of the fistula
• Injury to surrounding tissues
• Incontinence

Benefits

• Closure of the abnormal connection between the rectum and vagina
• Resolution of symptoms such as infection and incontinence
• Improved quality of life

Patients may begin to experience benefits shortly after recovery, typically within a few weeks.

Recovery

• Pain management with prescribed medications
• Instructions for wound care and hygiene
• Abstaining from heavy lifting and sexual activity for a certain period
• Follow-up appointments to monitor healing progress

Recovery generally takes a few weeks to a couple of months, depending on the individual case.

Alternatives

• Non-surgical management like the use of fibrin glue
• Staged surgical approaches if initial surgery fails
• Prolonged use of antibiotics for recurrent infections

Alternatives may offer less invasive options but often with a lower success rate compared to surgical intervention.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Postoperatively, discomfort and pain are common but can be managed with medications. Patients may also experience some temporary dietary restrictions and need assistance with daily activities during the early phase of recovery.