Successful laparoscopy-assisted repair of a rectovaginal fistula after low anterior resection for rectal cancer: a report of two cases

Abstract Background Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown a satisfactory outcome. We present two consecutive Japanese patients who underwent successful surgery for an RVF after low anterior resection. Case presentation The patients were two women (61-year-old and a 64-year-old). They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected at just oral side to the RVF. Thereafter, in combination with a perineal approach, the rectum, along with a previous anastomosis and fistula, were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both patients, the postoperative courses were uneventful. They complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months after diverting stoma closure. Conclusions A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for RVF after low anterior resection for rectal cancer.

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Successful Laparoscopy-assisted Repair of a Rectovaginal Fistula after Low Anterior Resection for Rectal Cancer: A Report of Two Cases

10.21203/rs.3.rs-94548/v1 ◽

2020 ◽

Author(s):

Hiroyuki Ohta ◽

Kyozo Hashimoto ◽

Tomoyuki Mizukuro ◽

Byonggu An ◽

Yumi Zen ◽

...

Keyword(s):

Rectal Cancer ◽

Connective Tissue ◽

Surgical Procedures ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Japanese Patients ◽

Vaginal Repair ◽

Diverting Stoma ◽

Double Stapling

Abstract Background: A rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown satisfactory outcomes. We present two consecutive Japanese patients who underwent successful surgery for a RVF after low anterior resection. Case presentation: The patients were a 61-year-old woman and a 64-year-old woman. They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both the patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected just before the RVF. Thereafter, in combination with a perineal approach, the rectum along with a previous anastomosis and fistula were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both the patients, the postoperative courses were uneventful. They have complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months respectively after diverting stoma closure.Conclusions: A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for an RVF after low anterior resection for rectal cancer.

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Rectovaginal Fistula after Low Anterior Resection for Rectal Cancer Using a Double Stapling Technique

Case Reports in Gastroenterology ◽

10.1159/000318745 ◽

2010 ◽

Vol 4 (2) ◽

pp. 224-228 ◽

Cited By ~ 11

Author(s):

Satoshi Yodonawa ◽

Isao Ogawa ◽

Susumu Yoshida ◽

Hiromichi Ito ◽

Keisuke Kobayashi ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Double Stapling Technique ◽

Stapling Technique ◽

Double Stapling

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Avoidance of rectovaginal fistula as a complication after low anterior resection for rectal cancer using a double-stapling technique

Journal of Surgical Oncology ◽

10.1002/(sici)1096-9098(199907)71:3<196::aid-jso11>3.0.co;2-r ◽

1999 ◽

Vol 71 (3) ◽

pp. 196-197 ◽

Cited By ~ 10

Author(s):

Tohru Nakagoe ◽

Terumitsu Sawai ◽

Takashi Tuji ◽

Atushi Nanashima ◽

Hiroyuki Yamaguchi ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Double Stapling Technique ◽

Stapling Technique ◽

Double Stapling

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Ligation and interposition of a modified Martius graft for rectovaginal fistula repair after low anterior resection for rectal cancer - a video vignette

Colorectal Disease ◽

10.1111/codi.13871 ◽

2017 ◽

Vol 19 (11) ◽

pp. 1037-1038

Author(s):

N. Uribe ◽

Z. Balciscueta ◽

M. C. Martin ◽

M. Lopez ◽

J. Tabet ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Fistula Repair ◽

Martius Graft ◽

Video Vignette

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The Use of a Circular Side Stapling Technique in Laparoscopic Low Anterior Resection for Rectal Cancer: Experience of 30 Serial Cases

International Surgery ◽

10.9738/intsurg-d-14-00202.1 ◽

2015 ◽

Vol 100 (6) ◽

pp. 979-983 ◽

Cited By ~ 2

Author(s):

Eiji Oki ◽

Koji Ando ◽

Hiroshi Saeki ◽

Yuichiro Nakashima ◽

Yasue Kimura ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Operating Time ◽

Colorectal Anastomosis ◽

Rectal Surgery ◽

Linear Stapler ◽

Stapling Technique ◽

Double Stapling ◽

Laparoscopic Assisted

The double-stapling technique using a circular stapler (CS) to create an end-to-end anastomosis is currently used widely in laparoscopic-assisted rectal surgery. However, a high rate of anastomotic failure has been reported. We report new side-to-side anastomosis creation using a CS, the so-called circular side stapling technique (CST). After excising the rectum at the oral and anal sides of the tumor with a linear stapler, a side-to-side colorectal anastomosis was made on the anterior wall of the rectosigmoid colon and the anterior or posterior wall of the rectum with a CS. Between 2012 and 2013, we recorded 30 serial cases of rectal-sigmoid or rectal cancer that were treated with laparoscopic-assisted surgeries using this method. In the 30 cases, the mean age was 68 ± 12 years, operating time was 288 ± 80 minutes, and blood loss was 66 ± 67 mL. None of the patients suffered from anastomosis leakage or postoperative anastomotic bleeding, and none complained of their stool habits. Three months after the last surgery in this cohort, no anastomosis strictures were reported. Based on these results, we propose an alternative method of side-to-side anastomosis for low anterior resection by using a CS to prevent staple overlap. Our experience indicates that the CST is easy and safe. Therefore, this method is a useful alternative to the current method used in laparoscopic surgery.

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Robot-assisted low anterior resection after aluminum potassium sulfate and tannic acid sclerosing therapy for internal hemorrhoids

Surgical Case Reports ◽

10.1186/s40792-019-0715-5 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Yoshiro Itatani ◽

Tomoaki Okada ◽

Kenji Kawada ◽

Koya Hida ◽

Nobu Oshima ◽

...

Keyword(s):

Rectal Cancer ◽

Tannic Acid ◽

Anterior Resection ◽

Low Anterior Resection ◽

Anal Verge ◽

Potassium Sulfate ◽

Robot Assisted ◽

Sclerosing Therapy ◽

Double Stapling ◽

Internal Hemorrhoids

Abstract Background Internal hemorrhoids are the most common anal diseases. Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for the treatment of internal hemorrhoids. Although ALTA injection has been widely used, there are no previous reports of rectal cancer patients who underwent robot-assisted low anterior resection (Rob-LAR) after ALTA injection to treat internal hemorrhoids. Case presentation A 70-year-old man with rectal cancer was presented to our hospital. He had an ALTA injection 2 months before presentation at a clinic due to hematochezia with internal hemorrhoids. The rectal tumor was located 7 cm above the anal verge, and Rob-LAR with the da Vinci Xi system was performed. The patient had sclerosis on the stump of the anal side, which made it difficult to transect the rectum with linear staplers. This required multiple repeats of compression through the SmartClamp feedback. After anastomosis with the double-stapling technique, we constructed a diverting ileostomy. Conclusion Although ALTA injection is a promising strategy for internal hemorrhoids, rectal cancer should be excluded before the sclerosing therapy.

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