Wu Dongyang,Chen Yajun,Wang Zengmeng,et al.Redo surgery for iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease[J].Journal of Clinical Pediatric Surgery,,21():1024-1028.[doi:10.3760/cma.j.cn101785-202204093-005]
Redo surgery for iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease
- Keywords:
- Megacolon; Hirschsprung’s Disease; Rectovaginal Fistula; Laparoscopes; Surgical Procedures; Operative
- Abstract:
- Objective To explore the causes of iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease (HD) and summarize the experiences and efficacies of reoperation.Methods From December 2007 to December 2020, retrospective review was conducted for clinical data of 6 HD children with iatrogenic rectovaginal fistula after pull-through.The surgical procedures for repairing rectovaginal fistula included transabdominal and transanal Soave, transperineal or transanal surgery.Results A total of six girls were included.Clinical manifestation was vaginal excretion.Injuries occurred in initial surgery (n=4) and during redo pull-through (n=2).The reasons for re-operation were postoperative abdominal hemorrhage and aganglionic segment residue.Rectovaginal fistula with anastomotic retraction and stenosis were successfully repaired by transabdominal and transanal Soave procedure in single time(n=4).The remaining two cases underwent simple local repair of rectovaginal fistula, including fistula closure after anal repair twice (n=1) and failed closure after five local (perineal/anal) repairs (n=1).Conclusion Rectovaginal fistula after pull-through in HD is a serious iatrogenic injury.It should be separated close to rectal submucosa/rectal wall to avoid vaginal injury.Transabdominal and transanal Soave procedure has a high success rate for repairing rectovaginal fistula and managing anastomotic retraction and stenosis.
References:
[1] Huang XJ, Tan SS, Chen YJ, et al.Acquired rectourethral and rectovaginal fistulas in children:a systematic review[J].Front Pediatr, 2021, 9:657251.DOI:10.3389/fped.2021.657251.
[2] Pe?a A, Elicevik M, Levitt MA.Reoperations in Hirschsprung disease[J].J Pediatr Surg, 2007, 42(6):1008-1014.DOI:10.1016/j.jpedsurg.2007.01.035.
[3] Sun S, Chen G, Zheng S, et al.Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease:experience with a single surgical group[J].J Pediatr Surg, 2017, 52(3):458-462.DOI:10.1016/j.jpedsurg.2016.08.016.
[4] Piper HG, Trussler A, Schindel D.Gracilis transposition flap for repair of an acquired rectovaginal fistula in a pediatric patient[J].J Pediatr Surg, 2011, 46(8):e37-e41.DOI:10.1016/j.jpedsurg.2011.05.004.
[5] Vogel JD, Johnson EK, Morris AM, et al.Clinical practice guideline for the management of anorectal abscess, fistula-in-ano and rectovaginal fistula[J].Dis Colon Rectum, 2016, 59(12):1117-1133.DOI:10.1097/DCR.0000000000000733.
[6] Sowande OA, Adejuyigbe O.Posterior sagittal approach in complicated Swenson’s pull-through[J].J Indian Assoc Pediatr Surg, 2008, 13(1):14-17.DOI:10.4103/0971-9261.42567.
[7] Liu GC, Xia HM, Wen YQ, et al.Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children[J].World J Pediatr, 2008, 4(1):53-57.DOI:10.1007/s12519-008-0011-0.
[8] Podevin G, Lardy H, Azzis O, et al.Technical problems and complications of a transanal pull-through for Hirschsprung’s disease[J].Eur J Pediatr Surg, 2006, 16(2):104-108.DOI:10.1055/s-2006-923995.
[9] Kosugi C, Saito N, Kimata Y, et al.Rectovaginal fistulas after rectal cancer surgery:incidence and operative repair by gluteal-fold flap repair[J].Surgery, 2005, 137(3):329-336.DOI:10.1016/j.surg.2004.10.004.
[10] Nerli RB, Koura A, Prabha V, et al.Acquired recto-urethral fistula in children:long-term follow-up[J].J Pediatr Urol, 2009, 5(6):485-489.DOI:10.1016/j.jpurol.2009.03.001.
[11] Ramírez-Martín D, Jara-Rascón J, Renedo-Villar T, et al.Rectourethral fistula management[J].Curr Urol Rep, 2016, 17(3):22.DOI:10.1007/s11934-016-0578-2.
[12] Corte H, Maggiori L, Treton X, et al.Rectovaginal fistula:what is the optimal strategy?:an analysis of 79 patients undergoing 286 procedures[J].Ann Surg, 2015, 262(5):855-861.DOI:10.1097/SLA.0000000000001461.
[13] Studniarek A, Abcarian A, Pan J, et al.What is the best method of rectovaginal fistula repair? A 25-year single-center experience[J].Tech Coloproctol, 2021, 25(9):1037-1044.DOI:10.1007/s10151-021-02475-y.
[14] 李颀, 张震, 李龙.先天性巨结肠再次手术的技术和技巧[J].临床小儿外科杂志, 2021, 20(3):208-211.DOI:10.12260/lcxewkzz.2021.03.002. Li Q, Zhang Z, Li L.Techniques and considerations of re-operations for Hirschsprung’s disease[J].J Clin Ped Sur, 2021, 20(3):208-211.DOI:10.12260/lcxewkzz.2021.03.002.
Memo
收稿日期:2022-04-25。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com