Abstract
The radiation-induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation-induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus-labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation.
Résumé
La cure des fistules vaginales secondaires à l'irradi ation est particulièrement difficile. Dans le passé en raison des mauvais résultats obtenus par les différents procédés de fermeture de la fistule, les chirurgiens eurent souvent recours en désespoir de cause soit à la colostomie, soit à la dérivation des urines. Cet article fait état d'une série de 25 cas de fistules vaginales secondaires à l'irradiation qui furent observées chez 22 malades et traitées par l'opération de Martius employant un lambeau graisseux provenant de la région labiale bulbocaverneuse. La guérison fut obtenue dans 84.2% des cas de fistules rectovaginales et 50% des cas de fistules vésicovaginales. Une seul opérée fut l'objet d'une réintervention. La morbidité fut peu importante et la mortalité nulle. Il ne fut jamais observé de sténose postopératoire qui aurait imposé une colostomie. Ces résultats et la simplicité relative de l'intervention permettent de considérer cette technique comme l'opération de choix d'autant que le réhabilitation de la malade est toujours satisfaisante.
Resumen
La fístula vaginal inducida por irradiaciones significa un desafío de rehabilitación particularmente difícil para el cirujano. Históricamente ha ocurrido un sentido de frustración sobre las perspectivas de éxito en el manejo de esta lesión, y muchos pacientes han sido manejados con colostomía o derivación urinaria permanentes. En este informe se revisa la experiencia personal con 25 fístulas vaginales inducidas por irradiación en 22 pacientes, utilizando la técnica del colgajo bulbocavernoso-labial de Martius. Se logró el cierre exitoso de la fístula en el 84.2% de las fístulas rectovaginales y en el 50% de las fístulas vesicovaginales. Sólo una paciente requirió un segundo procedimiento quirÚrgico para el logro del cierre. No se presentó mortalidad quirÚrgica y no hubo morbilidad quirÚrgica de significatcón. NingÚn paciente con la fístula rectovaginal ya cerrada requirió colostomía ulterior por estrechez. Estos resultados, junto con la relativa simplicidad del procedimiento, nos permiten recomendar esta técnica como una modalidad terapéutica de primera línea para estos problemas de difícil manejo. La mayoría de las pacientes se verá recompensada con una exitosa rehabilitación.
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Boronow, R.C. Repair of the radiation-induced vaginal fistula utilizing the martius technique. World J. Surg. 10, 237–248 (1986). https://doi.org/10.1007/BF01658140
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DOI: https://doi.org/10.1007/BF01658140