Successful repair of recurrent anovaginal fistula treated by gracilis muscle flap

초록

Anovaginal fistulae are uncommon type of anal fistulous disease. The symptoms can be minimal but frequently are disabling. Obstetric injury (85%) is the most common cause, but many other conditions such as radiation injury, inflammatory bowel disease, operative trauma and neoplasm can produce this abnormal communication. Reported success rates of the various approaches for repair of these fistulae are at least 75%. However special consideration of surgical intervention may be required in case of recurrent fistula, especially after failed previous repair attempts. A 47-year-old woman with recurrent anovaginal fistula was referred to our hospital. She suffered from 21 years after the second childbirth. She had undergone a transvaginal fistula excision and multilayer closure and transanal mucosal advanced flap repair for this fistula at two local community hospitals approximately 20 years and 3 years prior to this visit, respectively, but these previous surgical repairs had failed. A fistula opening measuring 2.0 cm x 3.0 cm was found at the lower anal canal just distal to the dentate line by the anoscopic and digital rectal examination (Figure 1). The fistula closure was successful after transposition of the gracilis muscle between vaginal and anal wall (Figure 2). The postoperative course was uneventful and she was discharged without complications on the 14th postoperative day. She did not develop recurrence for 7 months and quality of life after repair using gracilis muscle flap was satisfactory (Figure 3).