Repair of radiation-induced rectovaginal fistula with rectal stricture by a combined Tuttle, Turnbull-Cutait and Singapore flap approach

Radiation-induced rectovaginal fistula (RI-RVF) with associated rectal stricture represents a challenging problem in management. The aim of the present technical note is to describe a surgical technique aimed at minimizing disease recurrence by avoiding radiated tissue in the reconstruction: 1. Tutt...

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Bibliographic Details
Published in:Updates in surgery 2024-04, Vol.76 (2), p.713-717
Main Authors: Barzola, E., Kajmolli, A., Gachabayov, M., Bergamaschi, R.
Format: Article
Language:English
Subjects:
Anastomosis, Surgical - methods
Constriction, Pathologic - etiology
Constriction, Pathologic - surgery
Female
Humans
Medicine
Medicine & Public Health
Neoplasm Recurrence, Local
Rectal Neoplasms - pathology
Rectal Neoplasms - radiotherapy
Rectal Neoplasms - surgery
Rectovaginal Fistula - etiology
Rectovaginal Fistula - surgery
Rectum - pathology
Rectum - surgery
Singapore
Surgery
Technical Note
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Description
Summary:Radiation-induced rectovaginal fistula (RI-RVF) with associated rectal stricture represents a challenging problem in management. The aim of the present technical note is to describe a surgical technique aimed at minimizing disease recurrence by avoiding radiated tissue in the reconstruction: 1. Tuttle longitudinal incision of posterior vaginal wall with sharp excision of proximally located fistula; 2. Resection of strictured rectum via a combined transvaginal/laparotomy access, reconstruction with Turnbull-Cutait colon pull-through, and delayed handsewn coloanal anastomosis with loop ileostomy; 3. Bridge closure of the posterior vaginal wall by the interposition of a Singapore flap. This approach resulted in a favorable outcome at the 1-year follow-up in one patient with a medical history of gynecological carcinoma status after hystero-salpingo-oophorectomy followed by adjuvant radiation.
ISSN:2038-131X
2038-3312
DOI:10.1007/s13304-023-01701-6