Name of the Procedure:

Closure of Rectovaginal Fistula; Abdominal Approach

Summary

In this procedure, doctors repair an abnormal connection between the rectum and the vagina using an approach through the abdomen. It involves closing the fistula to restore normal function and prevent infections or other complications.

Purpose

The procedure addresses a rectovaginal fistula, which is an abnormal connection that can cause leakage of fecal matter into the vagina, leading to serious infections and discomfort. The primary goal is to close the fistula, restore proper separation between the rectum and vagina, and improve the patient's quality of life.

Indications

• Persistent and uncontrollable leakage of stool or gas from the vagina.
• Recurrent infections.
• Severe discomfort or pain in the pelvic area.
• Diagnosis confirmed via imaging or examination by a healthcare provider.

Preparation

• Patients are usually instructed to fast for at least 8 hours before the procedure.
• Bowel preparation may be required to clean the intestines.
• Preoperative tests such as blood work, imaging studies (e.g. MRI), and possibly a colonoscopy.
• Adjustment or temporary cessation of certain medications as advised by the healthcare provider.

Procedure Description

1. The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. A surgical incision is made in the abdomen to access the fistula.
3. The fistula tract is identified and carefully separated from the surrounding tissues.
4. The opening in the rectum is closed, followed by closure of the opening in the vagina.
5. The abdominal incision is then sutured, and sterile dressings are applied.
6. The procedure may involve the use of surgical tools such as retractors, sutures, and possibly laparoscopic equipment.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the fistula and any additional repairs required.

Setting

The procedure is performed in a hospital operating room under sterile conditions.

Personnel

• Surgeon (specializing in colorectal or gynecologic surgery)
• Surgical nurses
• Anesthesiologist
• Possibly a colorectal specialist or gynecologist assisting

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs
• Recurrence of the fistula
• Problems with bowel or urinary function

Benefits

• Relief from symptoms such as fecal leakage and recurrent infections.
• Improved comfort and quality of life.
• Restoration of normal anatomical structure and function.

Recovery

• Hospital stay of a few days for monitoring and initial recovery.
• Pain management with prescribed medications.
• Instructions on wound care and signs of infection to watch for.
• Gradual return to normal activities over 4-6 weeks.
• Follow-up appointments to monitor healing and ensure no recurrence.

Alternatives

• Non-surgical options such as medications and lifestyle changes, though often less effective for severe fistulas.
• Endoscopic or minimally invasive surgical options that might involve fewer risks but depend on the fistula size and location.

Patient Experience

• The patient will be under general anesthesia during the procedure, so they will not feel pain or be aware of the surgery.
• Post-procedure, patients might experience discomfort or pain managed with medications.
• Gradual improvement in symptoms is expected, with full benefits often realized within a few weeks to a couple of months.