Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently,
no single surgical intervention is universally regarded as the best treatment option
for rectovaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically
treated with a gracilis pull-through flap. The surgical goals in this patient were
complete excision of the recto-vaginal fistula and introduction of fresh, vascularized
muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior
to the present procedure. The gracilis muscle and tendon were mobilized, pulled through
the freshened recto-vaginal fistula, passed through the anus, and anchored externally.
Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks
demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage.
At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia.
At 6 months post-procedure, her stoma was closed. The patient reported transient fecal
staining of her vagina after stoma reversal, which resolved with conservative treatment.
The fistula had not recurred at 20 months post-procedure. The gracilis pull-through
flap is a reliable technique for a scarred vagina with an attenuated rectovaginal
septum. It can function as a well-vascularized tissue plug to promote healing.
Keywords
Rectovaginal fistula - Colorectal surgery - Reconstructive surgical procedures
