LAPAROSCOPIC REDO ENDORECTAL PULL-THROUGH PROCEDURE FOR COMPLEX RECTOVAGINAL FISTULA AFTER RECTAL RESECTION FOR ENDOMETRIOSIS

Subscribe to RSS DOI: 10.1055/s-0044-1781254 LAPAROSCOPIC REDO ENDORECTAL PULL-THROUGH PROCEDURE FOR COMPLEX RECTOVAGINAL FISTULA AFTER RECTAL RESECTION FOR ENDOMETRIOSIS Authors [email protected] Case Report This video presents a case of a patient who would not accept an ostomy, and the pull-through (PT) procedure was performed to avoid an ostomy. A 36-year-old woman underwent robotic segmental rectal resection with extraperitoneal colorectal anastomosis for intestinal endometriosis. During surgery, a colpotomy for endometrial implant resection was also undertaken. The patient developed an anastomotic leak and colpotomy breakdown in the postoperative course. She underwent reoperation four days after the anterior resection. A laparoscopic lavage and a protective ileostomy were performed. Three months of follow-up led to a diagnosis of a low rectovaginal fistula. At this point, the patient was unsatisfied with the ostomy and asked for immediate reversal. We decided to resect the failed anastomosis with a PT, vaginal defect repair, and ileostomy closure. This operation was performed 12 weeks after laparoscopic drainage. Colon stump resection and coloanal hand-sewn anastomosis were performed after eight days. The patient developed vaginal fecal discharge after seven days. An immediate redo PT was performed. Amputation of the colonic stump and re-anastomosis were performed after 11 days. The postoperative course was uneventful, and the patient was discharged after five days. Discussion Ostomies are related to poor quality of life, and deciding on an ostomy is a major issue in managing colorectal diseases. Some experts have proposed the PT procedure with delayed anastomosis as an alternative to the traditional immediate anastomosis to avoid the need of an ostomy. A meta-analysis evaluated the redo anastomosis for colorectal surgery and found no significant differences between delayed and immediate anastomoses. However, the literature on the subject is scarce. Given the lack of evidence, any decision should be shared with the patients and their values. Final Comments The omission of a protective ileostomy is feasible using PT. Surgeons should be aware of the procedure-related complications. Publication History Article published online: 27 February 2024 © 2024. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil