Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis

Introduction and hypothesis Endometriosis is a gynecological condition characterized by endometrial tissue outside of the uterus. It affects up to 15% of women of reproductive age. In the case of bowel infiltration, about 90% of lesions are localized on the sigmoid colon or the rectum and may interfere with bowel function. Three surgical approaches are possible: (1) shaving technique, (2) discoid resection of the nodule, and (3) segmental resection with end-to-end anastomosis. A rectovaginal fistula is feared as a postoperative complication mainly in simultaneous resection of the vaginal and the rectosigmoid nodules. Its prevention is a two-step surgery (the first operation on the vagina and the second on the colon) or a preventive colostomy, both of which are often thought to be too invasive for a benign condition. Herein, we suggest a one-step surgery to prevent its development.

In three women, a concomitant laparoscopic resection of the vaginal and rectosigmoid endometrial nodule was completed with interposition of a mesorectal flap.

All surgeries were uncomplicated with no rectovaginal fistula in the postoperative period.

In the hands of skilled surgeons, this one-step technique can be used to prevent rectovaginal fistula development.

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This work would not be possible without our surgical nurses and other colleagues, who took care of our patients. Author information Authors and Affiliations Corresponding author Ethics declarations Conflicts of interest None. Additional information Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Prior presentation This technique was presented at the 2018 European Endometriosis Conference in Vienna, Austria. Electronic supplementary material (MP4 67148 kb) Rights and permissions About this article Cite this article Hanacek, J., Havluj, L., Drahonovsky, J. et al. Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis. Int Urogynecol J 30, 2195–2198 (2019). https://doi.org/10.1007/s00192-019-04030-8 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00192-019-04030-8