Surgical Approach for Repair of Rectovaginal Fistula by Modified Martius Flap

Abstract

Rectovaginal fistulas (RVF) are rare but represent a challenge for both patients and surgeons. The most common cause of RVF is obstetric trauma, and treatment is based on fistula classification and localization of the fistula in relation to the vagina and rectum. Conventional therapy frequently fails, making surgery the most viable approach for fistula repair. One surgical procedure which offers adequate repair of lower and middle rectovaginal fistulas consists of interposition of a bulbocavernosus fat flap also called modified Martius flap. First described by Heinrich Martius in 1928, this approach has been continuously modified and adjusted over time and is used in the repair of various pelvic floor disorders. Overall success rates reported in the literature of the interposition of a Martius flap as an adjunct procedure in the surgical management of RVF are 65–100 %. We present a detailed description of the operation technique together with a discussion of the use of a dorsal-flapped modified Martius flap in the treatment of RVF.

Zusammenfassung

Rektovaginale Fisteln sind seltene, aber sowohl für die Patientinnen als auch für die behandelnden Ärzte herausfordernde Erkrankungen. Der häufigste Grund zur Entwicklung einer rektovaginalen Fistel ist das perineale Geburtstrauma, wobei sich die Therapie nach der Einteilung und der Lokalisation der Fistel in Bezug zu Vagina und Rektum richtet. Da die konservative Therapie meist insuffizient ist, muss in den meisten Fällen eine operative Sanierung durchgeführt werden. Eine Möglichkeit dazu stellt die Interposition gesunden Gewebes durch einen bulbokavernösen Fett- bzw. modifizierten Martius-Lappen dar, der 1928 durch Heinrich Martius erstbeschrieben wurde. Zusammen mit einem primären Fistelverschluss sind hohe Erfolgsraten von 65–100 % in der Literatur beschrieben. In dieser Literaturübersicht zur Sanierung rektovaginaler Fisteln mittels modifiziertem Martius-Lappen wird die Operationstechnik anhand der Fallbeschreibung einer Patientin mit komplizierter rezidivierender rektovaginaler Fistel detailliert beschrieben.

Key words

birth trauma - delivery - gynecology

Schlüsselwörter

Frauenheilkunde - Geburtstrauma - Stuhlinkontinenz

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