Materiały źródłowe

• #1 Treatment of Rectovaginal Fistula

  https://www.jstage.jst.go.jp/article/jarc/7/2/7_2023-007/_article

  Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. […] Size, fistula localization and etiology, type of fistula; „simple” or „complex,” status of anal sphincter complex and surrounding tissue, presence or absence of inflammation, presence of diverting stoma, previous attempted repair and radiation therapy, patient’s condition with co-morbidities, and surgeon’s experience are important factors to determine the management of RVF. […] The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. […] Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period.

• #2 The prevention of rectovaginal fistula after rectal cancer surgery by packing with laparoscopic dislocated fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma: a parallel group randomized controlled trial protocol | Trials | Ful

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07721-2

  Rectovaginal fistula (RVF) is an abnormal channel formed by epithelial tissue between the anterior wall of the rectum and the posterior wall of the vagina, which manifests as vaginal gassing and defecation. It is one of the common complications of female pelvic surgeries. With the increased number of proctectomies for rectal cancer, the number of postoperative rectovaginal fistulas also increases. […] Therefore, it is significant for female rectal cancer patients to prevent RVF after rectal cancer surgery. In this study, we introduce a new method to prevent RVF during rectal cancer radical operation. […] This RCT will explore the feasibility of packing with a laparoscopic dislocated fat flap containing an ovarian vascular pedicle anterior to the anastomotic stoma after rectal cancer surgery to prevent RVF.

• #3 Rectovaginal fistula after low anterior resection: Prevention and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8394379/

  Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. […] Strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations. […] Preventive strategies include adequate dissection of the rectum from the vagina and direct vision of the dissected posterior vaginal wall from a rectal transection line and a colorectal anastomosis as well as digital examination of the vagina before firing a circular staple. […] In a stapled colorectal anastomosis, it is advisable that a stapler pin should pass through the rectal stump posterior to the rectal transection line, thereby allowing more space between the vagina and the colorectal anastomosis. […] It is worth noting that RVF after rectal cancer surgery low anterior resection is secondary to colorectal anastomotic leakage in which a pelvic collection is drained through vaginal wall injuries missed in the index operation or through an unsecured vaginal stump during concomitant hysterectomy.

• #4 Rectovaginal fistula after low anterior resection: Prevention and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8394379/

  Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. […] Strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations. […] Preventive strategies include adequate dissection of the rectum from the vagina and direct vision of the dissected posterior vaginal wall from a rectal transection line and a colorectal anastomosis as well as digital examination of the vagina before firing a circular staple. […] In a stapled colorectal anastomosis, it is advisable that a stapler pin should pass through the rectal stump posterior to the rectal transection line, thereby allowing more space between the vagina and the colorectal anastomosis. […] It is worth noting that RVF after rectal cancer surgery low anterior resection is secondary to colorectal anastomotic leakage in which a pelvic collection is drained through vaginal wall injuries missed in the index operation or through an unsecured vaginal stump during concomitant hysterectomy.

• #5 Rectovaginal fistula after low anterior resection: Prevention and management

  https://www.wjgnet.com/1948-9366/full/v13/i8/764.htm

  Rectovaginal fistula after low anterior resection: Prevention and management […] Strategies to prevent rectovaginal fistula after low anterior resection are presented with illustrations. […] Because RVF after low anterior resection is usually caused by inadvertent incorporation of the posterior wall of the vagina into a colorectal anastomosis, the adequate dissection of the rectum from the vagina and direct vision of the dissected posterior vaginal wall from a rectal transection line and a colorectal anastomosis as well as digital examination of the vagina before firing a circular staple are essential steps before the creation of the anastomosis. […] Notably, in a stapled colorectal anastomosis, it is advisable that a stapler pin should pass through the rectal stump posterior to the rectal transection line, thereby allowing more space between the vagina and the colorectal anastomosis.

• #6 Rectovaginal fistula after low anterior resection: Prevention and management

  https://www.wjgnet.com/1948-9366/full/v13/i8/764.htm

  To a lesser extent, RVF after rectal cancer surgery low anterior resection is secondary to colorectal anastomotic leakage in which a pelvic collection is drained through vaginal wall injuries missed in the index operation or through an unsecured vaginal stump during concomitant hysterectomy. In this case, an intraoperative air leak test through the vagina may help to detect the missed injury to the vagina or unsecured vaginal stump.

• #7 The prevention of rectovaginal fistula after rectal cancer surgery by packing with laparoscopic dislocated fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma: a parallel group randomized controlled trial protocol | Trials | Ful

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07721-2

  Rectovaginal fistula (RVF) is an abnormal channel formed by epithelial tissue between the anterior wall of the rectum and the posterior wall of the vagina, which manifests as vaginal gassing and defecation. It is one of the common complications of female pelvic surgeries. With the increased number of proctectomies for rectal cancer, the number of postoperative rectovaginal fistulas also increases. […] Therefore, it is significant for female rectal cancer patients to prevent RVF after rectal cancer surgery. In this study, we introduce a new method to prevent RVF during rectal cancer radical operation. […] This RCT will explore the feasibility of packing with a laparoscopic dislocated fat flap containing an ovarian vascular pedicle anterior to the anastomotic stoma after rectal cancer surgery to prevent RVF.

• #8 The prevention of rectovaginal fistula after rectal cancer surgery by packing with laparoscopic dislocated fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma: a parallel group randomized controlled trial protocol | Trials | Ful

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07721-2

  Inspired by preventing RVF through packing the rectum and vagina with vascular pedicled greater omentum with its shortcomings, we propose the prevention of RVF by using autologous fat flap containing ovarian vascular pedicle to pack the rectum and vagina after radiotherapy and chemotherapy in female rectal cancer patients. […] The purpose of the study is to evaluate the effectiveness of the intervention methods (preventing rectovaginal fistula) in the experimental group, as well as the feasibility of their clinical implementation and promotion. […] The primary objective of this trial is to demonstrate the efficacy outcomes of the experimental group in preventing RVF. This includes monitoring the difference in incidence of RVF between the two groups. […] The mechanism of packing with a fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma is similar to that of greater omentum packing. The peripheral vessels of fat flap containing ovarian vascular pedicle may adhere to inflammatory tissue in the posterior wall of the vagina and form collateral circulation. The local blood flow of the posterior vaginal wall may be improved, providing rich nutrition and a good healing environment for the posterior vaginal wall. At the same time, ovarian vascular pedicle also strengthens the posterior wall of the vagina and the anterior wall of the rectum. All the above have played an important role in the prevention of RVF.

• #9 The prevention of rectovaginal fistula after rectal cancer surgery by packing with laparoscopic dislocated fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma: a parallel group randomized controlled trial protocol | Trials | Ful

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07721-2

  Inspired by preventing RVF through packing the rectum and vagina with vascular pedicled greater omentum with its shortcomings, we propose the prevention of RVF by using autologous fat flap containing ovarian vascular pedicle to pack the rectum and vagina after radiotherapy and chemotherapy in female rectal cancer patients. […] The purpose of the study is to evaluate the effectiveness of the intervention methods (preventing rectovaginal fistula) in the experimental group, as well as the feasibility of their clinical implementation and promotion. […] The primary objective of this trial is to demonstrate the efficacy outcomes of the experimental group in preventing RVF. This includes monitoring the difference in incidence of RVF between the two groups. […] The mechanism of packing with a fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma is similar to that of greater omentum packing. The peripheral vessels of fat flap containing ovarian vascular pedicle may adhere to inflammatory tissue in the posterior wall of the vagina and form collateral circulation. The local blood flow of the posterior vaginal wall may be improved, providing rich nutrition and a good healing environment for the posterior vaginal wall. At the same time, ovarian vascular pedicle also strengthens the posterior wall of the vagina and the anterior wall of the rectum. All the above have played an important role in the prevention of RVF.

• #10 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  Obstetric fistulae are almost entirely preventable with appropriate use of cesarean section. […] Prevention is the key to ending fistulae. UNFPA states that, „Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world.” […] Prevention comes in the form of access to obstetrical care, support from trained health care professionals throughout pregnancy, providing access to family planning, promoting the practice of spacing between births, supporting women in education, and postponing early marriage. […] Fistula prevention also involves many strategies to educate local communities about the cultural, social, and physiological factors of that condition and contribute to the risk for fistulae.

• #11 Obstetric Fistula Treatment | Surgeon | Healing Hands Clinic

  https://www.healinghandsclinic.co.in/obstetric-fistula-treatment/

  Prenatal care, with early identification of at-risk pregnancies and referral to tertiary centers for delivery is an important measure for prevention. […] Cesarean sections need to be more widely available as an option for the treatment of obstructed labor.

• #12 Prevention – Fistula Care Plus

  https://fistulacare.org/what-is-fistula/prevention/

  Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general. […] Family planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. […] The partograph is designed to act as an early warning system, alerting doctors, midwives, and nurses to the need for action e.g., referral to a higher level facility, labor augmentation, or cesarean section. […] If a woman with obstructed labor arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing. […] Timely cesarean section is critical for women with obstructed labor. […] Fistula Care Plus partners also work to prevent fistula at the community level.

• #13 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. […] NGOs also work with local governments, like the government of Niger, to offer free cesarean sections, further preventing the onset of obstetric fistulae. […] Promoting education for girls is also a key factor to preventing fistulae in the long term.

• #14 Prevention – Fistula Care Plus

  https://fistulacare.org/what-is-fistula/prevention/

  Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general. […] Family planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. […] The partograph is designed to act as an early warning system, alerting doctors, midwives, and nurses to the need for action e.g., referral to a higher level facility, labor augmentation, or cesarean section. […] If a woman with obstructed labor arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing. […] Timely cesarean section is critical for women with obstructed labor. […] Fistula Care Plus partners also work to prevent fistula at the community level.

• #15 Rectovaginal Fistula Treatment – Dr. Diego MarinesVisit our FacebookVisit our InstagramVisit our TwitterVisit our YouTube channelplay-circle-ochevron-downyoutube-playpause-circle-ophone-handsetlocationchevron-downmenu-circlecross-circlelinkedinfacebookpin

  https://drdiegomarines.com/anorectal-diseases-2/rectovaginal-fistula/

  Prevention of rectovaginal fistulas involves proper management of underlying medical conditions such as Crohn’s disease or cancer. Minimizing trauma during childbirth through proper prenatal care and delivery management can also help prevent this condition.

• #16 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Can you prevent a vaginal fistula? Developing a vaginal fistula is usually something you cant prevent. But you can be aware of the things that cause fistulas and try to modify those things. For example, you can: […] Manage chronic conditions like Crohns disease or ulcerative colitis. […] Treat pelvic infections right away and follow your providers exact treatment plan. […] Get regular prenatal care so that your provider can detect complications that may prolong your labor and delivery. […] Choose a provider who has extensive experience with surgeries like hysterectomies to minimize your risk for complications that lead to fistulas.

• #17 A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use | Gordon | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/308/172

  Pelvic organ prolapse (POP) is a condition of herniation of the pelvic organs into the vagina or past the introitus. Management options include pessary use. A very rare complication of pessary usage is erosion resulting in a vesicovaginal or rectovaginal fistula. […] For optimal outcomes with pessary use, we recommend that patients be actively managed with individualized periodic evaluations. Estrogen cream may be considered for prevention and treatment of eroded vaginal epithelium. […] The use of pessaries is an acceptable nonsurgical management option for patients with POP. However, patient selection and follow-up are a necessity to ensure successful and safe treatment. […] These areas of epithelial breakdown may be treated with conjugated vaginal estrogen cream, silver nitrate local cauterization, or application of topical lubricant jellies recommended by the pessary manufacturer.

• #18 A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use | Gordon | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/308/172

  The risk for major complication such as fistula formation from pessaries is believed to be low, but this may be due to under reporting in the literature. […] We also believe that estrogen cream may augment the healing process. The benefit of a colostomy for treatment of rectovaginal fistulas caused by pessary use is the diversion of stool away from the healing vaginal fistula, allowing the optimum opportunity for spontaneous resolution of the fistula and application of local estrogen therapy if desired. Subsequent surgical fistula closure, if desired by the patient, can be performed when medical and tissue factor issues are optimized.

• #19 Rectovaginal Fistula – MD Searchlight

  https://mdsearchlight.com/skin-problems-and-treatments/rectovaginal-fistula/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=28272

  Preventing Rectovaginal Fistula: After surgery, its important for patients to know how to reduce irritation and discomfort and help the healing process. Here are a few tips: Only clean the surgical area with water. If soap is necessary, make sure to use a mild, fragrance-free type. Stay away from perfumed tampons and vagina-cleaning products. Make sure the area is completely dry before covering it. Wear underwear and clothing thats loose-fitting, ideally made from cotton, as it lets your skin breathe. Use unscented baby powder or creams that protect against moisture to keep the area dry.

• #20 Proposal for Reclassification Of Rectovaginal Fistulas | CEG

  https://www.dovepress.com/rectovaginal-fistulas-not-involving-the-rectovaginal-septum-should-be–peer-reviewed-fulltext-article-CEG

  Many rectovaginal fistulas(RVF), especially low RVF, do not involve/penetrate the RV-septum, but due to lack of proper nomenclature, such fistulas are also managed like RVF (undertaking repair of RV-septum) and inadvertently lead to the formation of a high RVF (involving RV-septum) in many cases. Therefore, REctovaginal Fistulas, Not Involving the Rectovaginal Septum, should be Treated like Anal fistulas(RENISTA) to prevent any risk of injury to the RV septum. […] RVF not involving RV-septum were managed like anal fistulas with a high cure rate and no significant change in continence. RV-septum injury or formation of RVF with septum involvement did not occur in any patient. The RENISTA concept was validated in the present study. A new classification was developed to prevent any inadvertent injury to the RV-septum.

• #21 Proposal for Reclassification Of Rectovaginal Fistulas | CEG

  https://www.dovepress.com/rectovaginal-fistulas-not-involving-the-rectovaginal-septum-should-be–peer-reviewed-fulltext-article-CEG

  Therefore, we logically hypothesized that REctovaginal fistulas, Not Involving Septum, should be Treated like Anal fistulas (RENISTA). We, therefore, proposed a reclassification of RV fistulas, which could guide the surgeons to better and more safely manage the repair of these risky conditions and help prevent any risk of injury to the RV-septum. […] The RENISTA [REctovaginal fistulas, Not Involving Septum (RVF-II), should be Treated like Anal fistulas] concept was vindicated by the results of the study in which 27 RVF-II patients were managed like anal fistula with a high success rate (91.7%) on a median follow-up of 15 months. […] The important contribution of the present study could be that the involvement of RV-septum by RVF should be utilized to classify these fistulas as RVF-I (RVF involving RV-septum) and RVF-II (RVF not involving RV-septum). RVF-II would include most low-RVF, anovaginal, and transperineal fistulas. The RENISTA (REctovaginal fistulas Not Involving Septum are Treated like Anal fistulas) concept formed the basis of treatment. RVF-I should undergo conventional RVF treatment, while its the opinion of the authors that RVF-II can be safely and conveniently treated like anal fistulas and that this can prevent any accidental injury to the RV septum in type-II patients.

• #22 Treatment of Rectovaginal Fistula

  https://www.jstage.jst.go.jp/article/jarc/7/2/7_2023-007/_article

  Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. […] Size, fistula localization and etiology, type of fistula; „simple” or „complex,” status of anal sphincter complex and surrounding tissue, presence or absence of inflammation, presence of diverting stoma, previous attempted repair and radiation therapy, patient’s condition with co-morbidities, and surgeon’s experience are important factors to determine the management of RVF. […] The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. […] Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period.

• #23 Treatment of Rectovaginal Fistula

  https://www.jstage.jst.go.jp/article/jarc/7/2/7_2023-007/_article

  Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient’s pain. […] Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs.

• #24 Rectovaginal Fistula Guidelines: ASCRS Guidelines for Rectovaginal Fistula

  https://emedicine.medscape.com/article/193277-guidelines

  Nonoperative management is typically recommended for the initial care of obstetrical rectovaginal fistula and may also be considered for other benign and minimally symptomatic fistulas. […] A draining seton may facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas. […] Endorectal advancement flap with or without sphincteroplasty is the procedure of choice for most patients with a rectovaginal fistula. […] Episioproctotomy may be used to repair obstetrical or cryptoglandular rectovaginal fistulas in patients with anal sphincter defects. […] A gracilis muscle or bulbocavernosus (Martius) flap is typically recommended for recurrent or otherwise complex rectovaginal fistula. […] Rectovaginal fistulas that result from colorectal anastomotic complications often require a transabdominal approach for repair. […] Completion proctectomy with or without colonic pull-through or coloanal anastomosis may be required to treat radiation-related or recurrent complex rectovaginal fistula.

• #25 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  Obstetric fistulae are almost entirely preventable with appropriate use of cesarean section. […] Prevention is the key to ending fistulae. UNFPA states that, „Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world.” […] Prevention comes in the form of access to obstetrical care, support from trained health care professionals throughout pregnancy, providing access to family planning, promoting the practice of spacing between births, supporting women in education, and postponing early marriage. […] Fistula prevention also involves many strategies to educate local communities about the cultural, social, and physiological factors of that condition and contribute to the risk for fistulae.

• #26 Obstetric fistula – Wikipedia

  https://en.wikipedia.org/wiki/Obstetric_fistula

  It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. […] NGOs also work with local governments, like the government of Niger, to offer free cesarean sections, further preventing the onset of obstetric fistulae. […] Promoting education for girls is also a key factor to preventing fistulae in the long term.

• #27 Fistulas | Symptoms & Treatment | CU Urogynecology | Denver, CO

  https://urogyn.coloradowomenshealth.com/conditions/colon-bowel/fistulas.html

  Fistulas are preventable and treatable. […] Proper medical care makes fistulas both treatable and preventable.

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