Modified Martius Flap for Rectovaginal Fistula

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
  • Distributed in newsletters, featured on our website and social media
  • Peer reviewed

Author: June Hsu
Published:
Specialties: Gastrointestinal Surgery, General Surgery, Obstetrics and Gynecology
Schools:
0 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 5 (0 votes, average: 0.00 out of 5)
You need to be a registered member to rate this post.
Loading...
Basic Info

Contributors: Dr. Jimmy Lin, Dr. Juana Hutchinson-Colas, Dr. Nell Maloney-Patel

Rectovaginal fistulas can occur for a number of reasons, including obstetric trauma, iatrogenic, radiation damage and Crohn’s disease. Symptoms range from asymptomatic to uncontrollable passage of gas or feces from the vagina leading to poor quality of life for some patients. For those patients whom surgery is indicated, there are several different approaches depending on the fistula etiology and previous attempts at repair. These range from simple fistulectomy to transabdominal repair with tissue interposition to Martius flap interposition. Our patient in the video had previously underwent multiple various repairs which failed to provide adequate resolution of her fistula and therefore presented for a Modified Martius flap repair. The benefit of such a repair is to provide neovascularity at the site of repair with minimal cosmetic effect.

Advanced

Procedure

Modified Martius flap for rectovaginal fistula

Indications

Repair of rectovaginal fistula after multiple failed attempts

Contraindications

Pre-existing dyspareunia (relative)

Instrumentation

Setup

Lithotomy position

Preoperative Workup

CT scan, digital rectal exam, vaginal exam, colonoscopy

Anatomy and Landmarks

vagina, introitus, rectum, rectovaginal septum, labial fat pad

Advantages/Disadvantages

Advantages: Interposition of healthy, vascularized tissue in the rectovaginal septum
Disadvantage: Impaired labial function, poor cosmesis

Complications/Risks

Risks: Dyspareunia

Disclosure of Conflicts

No conflicts to disclose.

Acknowledgements

References

Hokenstad ED, Hammoudeh ZS, Tran NV, Chua HK, Occhino JA. 2016. Rectovaginal fistula repair using a gracilis muscle flap. Int Urogynecol J. 27(6):965-7.

Khalil HH, Malahias MN, Karandikar S, Hendrickse C.2016, Internal pudendal artery perforator island flap for management of recurrent benign rectovaginal fistula. Plast Reconstr Surg Glob Open. 10;4(8):e841.

Kniery KR, Johnson EK, Steele SR. 2015. Operative considerations for rectovaginal fistulas. World J Gastrointest Surg. 27;7(8):133-7.

Lalwani S, Varma V, Kumaran V, Mehta N, Nundy S. 2015, Complex rectovaginal fistula- an experience at a tertiary care center. Indian J Surg. 77(Suppl 3):1142-7

Lo TS, Huang YH, Dass AK, Karim N, Uy-Patrimonio MC. 2016, Rectovaginal fistula: twenty years of rectovaginal repair. J Obstet Gynaecol Res. 42(10):1361-1368

Oakley SH, Brown HW, Yurteri-Kaplan L, Greer JA, Richardson ML, Adelowo A, Lindo FM, Greene KA, Fok CS, Book NM, Saiz CM, Plowright LN, Harvie HS, Pauls RN. 2015, Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows’ Pelvic Research Network. Female Pelvic Med Reconstr Surg. 21(3):123-8.

Share
0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply