Name of the Procedure:

Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication

Summary

This surgical procedure involves repairing an abnormal connection between the rectum and vagina, known as a rectovaginal fistula. The repair is done through a transperineal approach, which includes reconstructing the perineal body and may or may not involve strengthening the levator muscles.

Purpose

This procedure addresses rectovaginal fistulas, which can cause significant discomfort, infection, and hygiene issues for the patient. The goal is to close the fistula, restore normal anatomy, and improve quality of life by preventing fecal matter from passing into the vagina.

Indications

• Persistent or recurrent infections in the genital or anal area.
• Fecal incontinence or passage of gas through the vagina.
• Pain and discomfort during bowel movements or sexual activity.
• Previous non-surgical treatments that have failed to close the fistula.

Preparation

• Fasting for at least 8 hours before the surgery.
• Adjustments to medications as directed by the healthcare provider.
• Pre-operative antibiotics to reduce the risk of infection.
• Diagnostic tests such as an MRI or colonoscopy to evaluate the fistula.

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made in the perineal area to access the fistula.
3. The fistula tract is identified and carefully dissected.
4. The rectal and vaginal walls are repaired, closing the fistula.
5. The perineal body is reconstructed to its normal anatomical position.
6. If necessary, the levator muscles are plicated (tightened and sutured).
7. The incision is closed with sutures.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeons (General Surgeon or Colorectal Surgeon)
• Anesthesiologist
• Nurses
• Surgical Technicians

Risks and Complications

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

Benefits

• Improved hygiene and reduced risk of infections.
• Alleviation of discomfort and pain.
• Enhanced quality of life through the restoration of normal anatomical function.
• Potential return to normal sexual and bowel function within a few weeks to months.

Recovery

• Hospital stay for 3-5 days.
• Pain management through prescribed medications.
• Instructions for wound care and hygiene.
• Avoiding strenuous activities and heavy lifting for at least 6 weeks.
• Follow-up appointments to monitor healing and address any complications.

Alternatives

• Non-surgical management, such as draining abscesses or using setons (silk or rubber threads).
• Endoscopic procedures.
• Use of fibrin glue to seal the fistula.
• Each alternative comes with its own risks and benefits and may be less effective in severe cases.

Patient Experience

• Discomfort and pain managed with medications.
• Possible catheter use for the first few days post-surgery.
• Gradual return to normal activities with proper care and monitoring.
• Emotional and psychological support may be necessary due to the nature of the condition and recovery.