The first experience of using «evagination» method in patients with rectovaginal fistulas

Despite the variety of methods of rectovaginal fistulas surgery, the recurrence of the disease reaches 80 % of cases. The «evagination» method was proposed in the NMRC of coloproctology for the combined treatment of RVF and anal sphincter insufficiency. The study included 10 women with rectovaginal fistula and anal sphincter insufficiency. The age of patients was from 25 to 52 (33,6 ± 7,73) years. Etiology of rectovaginal fistula: postpartum — 7 (70.0 %); iatrogenic — 2 (20.0 %); malformation — 1 (10.0 %). The follow-up period ranged from 4 to 14 months (8,4 ± 2,9). The «evagination» method was used in all patients. The disease recurrence occurred in 1 patient (10.0 %) on the 8th day after surgery. Conclusion: the «evagination» method can be considered as a surgery of choice in the treatment of extended defects of the rectovaginal septum with anal sphincter insufficiency due to its defect.

Incidence rate and structure of external genital endometriosis in hospital patients

Aim. To assess the frequency of genital endometriosis and its various forms based on the analysis of hospitalized morbidity. Materials and methods. Analysis of the medical data base of the gynecological clinic of the Gorodkov Ivanovo Research Institute of Maternity and Childhood for the period 20002019. The unit of observation is a case of endometriosis in a patient who left the gynecological clinic of a 24-hour hospital. The clinical characteristics of the prevalence of genital endometriosis are given based on the analysis of 9.378 surgery protocols for the period 20002019. The stages of spread of the endometrioid process were assessed according to the 1985 R-AFS classification. Results. The total number of patients diagnosed with endometriosis was 17% of the total number of gynecological patients. The proportion of hospitalized with endometriosis in 20002019 increased by 2 times from 4.5 to 9.2%. Over 20 years, the proportion of patients with endometriosis of the uterus (N80.0) from 36.2 to 9.0% (p0.001), with endometriosis of the rectovaginal septum and vagina (N80.4) decreased from 2.6 to 0% (p0.01). The proportion of patients with ovarian endometriosis (N80.1) increased from 12.1 to 34.6% (p0.001), pelvic peritoneal endometriosis (N80.3) from 16.5 to 51.1% (p0.001). The proportion of patients with endometriosis of two or more localizations increased from 1.6 to 40.2% (p0.001). Over the 20-year period, there was a decrease in the average age of patients with endometriosis from 37.80.43 years in 2000 to 36.20.34 years in 2009 and 33.80.29 years in 2019 (p0.001). The range of fluctuations in age characteristics ranged from 13 to 55 years. The overwhelming majority of observations are minor forms (I and II stages of the disease) 57.6%. Retrocervical endometriosis was diagnosed in 20.1%. Endometrioid ovarian cysts were in 11.7% of cases. In most cases, endometriotic lesions were combined with adhesions of the small pelvis. Conclusion. Thus, genital endometriosis is a common gynecological pathology, which is often the reason for hospitalization for surgical intervention in women of different age groups. However in most cases affects in most important period in a womans life reproductive. The given data emphasize the need to study and develop therapeutic measures to improve the system of organizing medical care, to find the most optimal and effective forms of diagnosis, approaches to the treatment and rehabilitation of women with endometrisis, which would significantly reduce the volume of surgical interventions, thus reducing financial costs, including overcoming infertility.

Molecular Analysis of an Abdominal Wall Cesarean Section Endometrioid Carcinoma

Malignant transformation of endometriosis is rare, and most cases concern the ovaries, while extraovarian cases are mostly found in the rectovaginal septum. Incisional adenocarcinoma is extremely rare, with only few cases reported in the literature, while their molecular profile remains unknown. Thus, we report on an abdominal wall cesarean section scar endometrioid adenocarcinoma studied by next-generation sequencing and microsatellite instability analysis.

Endometriosis of the Rectus Abdominis Muscle: A Rare Cause of Emergency Department Visit; Case Report

Introduction: Endometriosis affects approximately 10% of the reproductive age woman. Although the most common affected sites are ovaries, sacrouterine ligament, rectovaginal septum, and pelvic peritoneum, it can be located in any organ. Endometriosis of rectus abdominal muscle independent from the cesarean section incision is extremely rare. Case Presentation: A 31-years-old female was admitted to the emergency department with periodical abdominal pain and distension complaints. Ultrasonography and computed tomography revealed a heterogeneous mass in the rectus abdominis muscle. Surgical excision was performed. Histopathologic examination showed endometrial tissue with glandular and stromal elements within the muscularis propria. Conclusion: Endometriosis should be kept in mind in the differential diagnosis of atypical pain and mass of the abdominal wall in the emergency settings.

Rectovaginal extragastrointestinal stromal tumour (EGIST): an additional entity to be considered in the differential diagnosis of tumours of the rectovaginal septum

Gastrointestinal stromal tumours (GISTs) are rare - and rectovaginal extragastrointestinal stromal tumours (RV-EGISTs) even rarer. We share a case of RV-EGIST, complemented by high-quality radiological and surgical images. A review of current literature pertaining to RV-EGIST is also included. Our case report highlights the diagnostic challenge presented by extragastrointestinal stromal tumours. Differentiated from overlapping pathologies only by targeted application of immunohistopathology and cytogenetics, the inclusion of RV-EGIST in the differential diagnosis of a rectovaginal tumour is essential to making this correct diagnosis. Primary surgery is the treatment of choice for RV-EGIST if complete cytoreduction can be achieved, combined with adjuvant tyrosine kinase inhibitor (TKI) therapy for those with high-risk features to further reduce rates of future recurrence.

Surgical treatment of patients with deep infiltrating endometriosis of the rectovaginal septum

Objective. To optimize the tactics of surgical treatment of deep infiltrating endometriosis of the rectovaginal septum, including with bowel involvement. Patients and methods. The study included 122 patients diagnosed with deep infiltrating endometriosis of the rectovaginal septum, who underwent surgical interventions of different volumes using laparoscopy. The patients were divided into a main group and a comparison group. The main group consisted of 92 patients with deep infiltrating endometriosis of the rectovaginal septum who underwent surgical treatment using the original technique of systematic approach; the comparison group consisted of 30 patients who were operated using the generally accepted technique. Results. There was a statistically significant decrease in the operation duration, intraoperative blood loss, as well as more effective relief of dysmenorrhea and chronic pelvic pain syndrome, less complications and relapses in the main group compared to the comparison group. In addition, it was found that the combination of three symptoms such as dysmenorrhea, dyspareunia and chronic pelvic pain increase the likelihood of deep infiltrating endometriosis up to 93%. Conclusion. Based on the results obtained, the proposed method of surgical treatment of deep infiltrating endometriosis is more efficient and safer in comparison with the generally accepted technique, which can be considered as a valid reason for its wide introduction into clinical practice. Key words: deep infiltrating endometriosis, bowel endometriosis, surgical treatment of endometriosis, treatment algorithm

Proctogyneacology – who should treat? A proposed treatment algorithm

Proctogyneacology deals with conditions involving the anal canal, anal sphincter muscles, rectum, rectovaginal septum, and the female reproductive tract. They may be due to sagging of the pelvic floor and the rectovaginal septum (rectal, vaginal or uterine prolapse, enterocele and rectocele), perinatal injury, including sphincter damage, rectovaginal fistulas, endometriosis with anal sphincter and rectovaginal septum involvement, proctological inflammatory diseases in pregnancy, as well as radiation-induced rectal damage after gynaecological cancer treatment. There are no set guidelines defining which specialist should operate on these patients. We attempted to systematise this issue in the form of an algorithm. An interdisciplinary dialogue allowing for our professional development and, most of all, therapeutic success and reduced risk of postoperative complications, seems to be crucial.

Review of Denonvilliers’ fascia: the controversies and consensuses

The Denonvilliers’ fascia (DVF) plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs. It affects the surgical plane anterior to the rectum in the procedure of total mesorectal excision (TME). Anatomical and embryological studies have helped us to understand this structure to some extent, but many controversies remain. In terms of its embryonical origin, there are three mainstream hypotheses: peritoneal fusion of the embryonic cul-de-sac, condensation of embryonic mesenchyme, and mechanical pressure. Regarding its architecture, the DVF may be a single, two, or multiple layers, or a composite single-layer structure. In women, most authors deem that this structure does exist but they are willing to call it the rectovaginal septum rather than the DVF. Operating behind the DVF is supported by most surgeons. This article will review those mainstream studies and opinions on the DVF and combine them with what we have observed during surgery to discuss those controversies and consensuses mentioned above. We hope this review may help young colorectal surgeons to have a better understanding of the DVF and provide a platform from which to guide future scientific research.