Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis

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This video demonstrates three surgical techniques—mucosal flap, transanal transection and single stapled anastomosis (TTSS), and pull through—for correcting rectovaginal fistulas following rectal resection for deep endometriosis.

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This paper presents a set of surgical video case demonstrations on repairing rectovaginal fistulas (RVF) that occur after low rectal resection in the setting of deep endometriosis, combining perineal surgery with laparoscopy. The authors show three techniques—a mucosal flap, a transanal transection with single stapled anastomosis (TTSS), and a pull-through—describing how repair can be adapted to limit functional consequences. The work is primarily descriptive and does not provide comparative outcomes or additional research data beyond the submitted manuscript/video. This paper is centrally about endometriosis — specifically, it documents rectovaginal fistula repair techniques following bowel surgery for deep endometriosis.

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Abstract

Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB).
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Abstract

Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB) Similar content being viewed by others Data Availability No research data are available outside the submitted manuscript file.

References

Viganò P, Parazzini F, Somigliana E, Vercellini P (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 18(2):177–200 International Working Group of AAGL, ESGE, ESHRE and WES, Tomassetti C, Johnson NP et al (2021) An international terminology for endometriosis. Hum Reprod Open 2021(4):hoab029 Falcone T, Flyckt R (2018) Clinical management of endometriosis. Obstet Gynecol Mars 131(3):557–571 Abo C, Moatassim S, Marty N et al (2018) Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril 109(1):172–178.e1 Zheng Y, Zhang N, Lu W et al (2018) Rectovaginal fistula following surgery for deep infiltrating endometriosis: does lesion size matter? J Int Med Res 46(2):852–864 Roman H, Dennis T, Forestier D et al (2023) Excision of deep rectovaginal endometriosis nodules with large infiltration of both rectum and vagina: what is a reasonable rate of preventive stoma? A comparative study. J Minim Invasive Gynecol 30(2):147–155 Spinelli A, Foppa C, Carvello M et al (2021) Transanal transection and single-stapled anastomosis (TTSS): a comparison of anastomotic leak rates with the double-stapled technique and with transanal total mesorectal excision (TaTME) for rectal cancer. Eur J Surg Oncol 47(12):3123–3129. https://doi.org/10.1016/j.ejso.2021.08.002 Author information Authors and Affiliations Contributions A.P. and C.J. edited the video and participated in one of the three surgeries. They wrote the manuscript together. Q.D., M.-O.F and V.A. were the colorectal surgeons in these videos. T.D., B.M. and H.W. were the gynecologists of these patients. All authors reviewed the manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interests as defined by Springer, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Potolicchio, A., Jehaes, C., Merlot, B. et al. Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis. Tech Coloproctol 28, 51 (2024). https://doi.org/10.1007/s10151-024-02923-5 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s10151-024-02923-5

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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