MARTIUS FLAP INTERPOSITION WITH CYANOACRYLATE REINFORCEMENT AND LAPAROSCOPIC LOOP ILEOSTOMY FOR RECURRENT RECTOVAGINAL FISTULA giselaoropeza@outlook.com

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MARTIUS FLAP INTERPOSITION WITH CYANOACRYLATE REINFORCEMENT AND LAPAROSCOPIC LOOP ILEOSTOMY FOR RECURRENT RECTOVAGINAL FISTULA

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Billy Jiménez Bobadilla edualvatame@gmail.com Hospital General de México Coloproctología Ciudad de México Mexico

Mexico

Oral or Poster

Rectovaginal fistulas are rare epithelialized tracts between rectum and vagina (5% of anorectal fistulas; 0.3–0.5/1,000 births), mostly obstetric in origin (88%; 0.1% after episiotomy), and are clinically challenging with major functional impact.

We precent a case report of a recurrent rectovaginal fistula after three prior repairs underwent reconstruction with a right Martius flap based on the external pudendal artery, tunneled into the rectovaginal space, complemented by a laparoscopic loop ileostomy. The postoperative course was uneventful, and follow-up confirmed complete fistula closure without complications or recurrence.

53-year-old woman with an RVF secondary to a complicated vaginal delivery (third-degree perineal tear with sphincter injury),after three failed repairs (transanal 15 years ago, rectal advancement flap 8 years ago, collagen plug 3 years ago).She underwent Martius flap reconstruction: modified lithotomy, fistula cannulation and debridement; an 8×3 cm right labial fat flap preserving the external pudendal artery was tunneled to the rectovaginal space and secured to the rectal defect with 3-0 absorbable sutures in two layers.The repair was reinforced with cyanoacrylate at the flap–posterior vaginal wall interface, followed by layered closure with 4-0 monofilament; the protective ileostomy was maintained.Postoperative course was favorable, 7 days of prophylactic antibiotics, discharge on postoperative day 5 without complications.

In recurrent rectovaginal fistula after three failed repairs, a Martius flap with laparoscopic protective ileostomy achieved complete healing without complications or recurrence. Benefits likely stem from neovascularization and plane separation, aiding functional recovery. Results support this safe, effective option; cyanoacrylate may improve closure, but prospective studies should refine indications