Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
Section Ii:
2-17
2-17. RECTOVAGINAL FISTULA REPAIR--VAGINAL APPROACH
a. General.
(1) This procedure involves vaginal repair of the perineum, fascia, and muscle-supporting structures between the rectum and vagina, thereby closing the fistula formed between the rectum and the vagina.
(2) A rectovaginal fistula occurs between the rectum and the vagina. In the presence of a large rectovaginal fistula, a colostomy may be done.
b. Operative Procedure.
(1) The scar tissue and tract between the rectum and vagina are excised; edges of fresh tissue are approximated with sutures of chromic gut number4-0.
(2) The rectum and vaginal walls are mobilized; the rectum is closed in layers with inversion of the mucosa into the rectal canal.
(3) The levator ani is approximated between the rectum and vaginal.
(4) The vagina is closed transversely or in a sagittal plane different from that of the rectal canal; the vaginal mucosal layer is inverted into the vaginal wall; an indwelling urinary drainage system is established; and dressings are applied to the wound.
