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Operative Results and Quality of Life After Gracilis Muscle Transposition for Recurrent Rectovaginal Fistula

Lefèvre, J H. M.D.; Bretagnol, F M.D.; Maggiori, L M.D.; Alves, A M.D., Ph.D.; Ferron, M M.D.; Panis, Y M.D., Ph.D.

Diseases of the Colon & Rectum: July 2009 - Volume 52 - Issue 7 - p 1290-1295
doi: 10.1007/DCR.0b013e3181a74700
Original Contribution

PURPOSE: The aim of this study was to assess the efficacy of gracilis muscle transposition for recurrent rectovaginal fistula.

METHODS: Gracilis muscle transposition for recurrent rectovaginal fistula was performed in eight patients. Causes of fistulas included Crohn's disease (n = 5), perineal surgery (n = 2), and obstetrical injury (n = 1). All patients underwent a mean of three (range, 1–6) previous repairs. Fecal diversion was performed in all cases.

RESULTS: Six of eight patients (75%) healed after gracilis muscle transposition alone. The other two patients required a second gracilis. These two patients failed with another recurrence and one of them underwent laparotomy with successful omental interposition. Thus, after a median follow-up of 28 (range, 4–55) months, the per-gracilis muscle transposition healing rate was 60% (6/10) and the overall healing success rate after gracilis muscle transposition and other procedures was 88% (7/8). For patients with Crohn's disease, four of five (80%) presented no recurrent rectovaginal fistula. Seven of eight patients underwent ileostomy closure after gracilis, but two required subsequent stomas, one for a late recurrence. Overall, five of eight patients are stoma-free. Despite healing, postoperative quality of life and sexual activity remained significantly altered.

CONCLUSION: Gracilis muscle transposition can be proposed in cases of recurrent rectovaginal fistula. The procedure has a good success rate, especially in Crohn's disease patients.

Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital (AP-HP), Clichy, France

Address of correspondence: Yves Panis, M.D., Ph.D., Pôle des Maladies de l'Appareil Digestif (PMAD), Service de Chirurgie Colorectale, Hôpital Beaujon (AP-HP), 100 boulevard du Général Leclerc, 92118 Clichy cedex, France. E-mail:

© The ASCRS 2009