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

• 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
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-023-01701-6

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.