A NOVEL RECONSTRUCTIVE STRATEGY FOR COMPLEX MID AN waheebradman@yahoo.com

 

A NOVEL RECONSTRUCTIVE STRATEGY FOR COMPLEX MID AN

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Yemen

Oral only

Rectovaginal fistulas (RVFs) present a significant surgical challenge. Aims to describe and evaluate a novel surgical approach combining a modified Martius flap with levatorplasty, overlapping sphincteroplasty, and fibromuscular perineal body reconstruction in patients with complex RVFs and continence dysfunction following obstructed labor or gynecological trauma.

From December 2009 to December 2024, 60 women with rectovaginal fistulas due to obstetric trauma or failed repairs underwent a standardized reconstructive procedure. All presented with fecal incontinence and perineal soiling. Surgery included layered fistula closure, overlapping sphincteroplasty, posterior levatorplasty, and fibromuscular perineal body reconstruction by uniting remnants of key pelvic floor muscles. A vascularized Martius flap was transposed to reinforce healing. Patients were followed for at least 12 months to evaluate fistula closure, continence restoration, and satisfaction.

Successful anatomical closure of the fistula was achieved in 59 of the 60 patients, reflecting a primary healing rate of 98.3%. Functional outcomes were also favorable, with 54 patients (90%) experiencing significant improvement in continence. Overall satisfaction was high, reported by 96.7% of participants. Importantly, there were no incidences of major flap necrosis or deep pelvic infections throughout the follow-up period.

RVFs are inherently complex, often involving recurrence, tissue loss, sepsis, and require a tailored, multifaceted surgical approach. This modified technique addresses both anatomical and functional challenges, especially in cases with perineal body loss from obstetric or gynecologic trauma. By combining fibromuscular reconstruction with sphincteroplasty, levatorplasty, and Martius flap transposition, this approach effectively restores pelvic support and continence, offering a dependable solution for complex or recurrent RVFs.