And COLON

ALGORITHM OF DIAGNOSTIC AND TREATMENT MEASURES IN RECTOVAGINAL FISTULAS

G.A. ABBASOVA, E.A.JAVADOV

City Clinical Hospital No. 5, Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN

Rectovaginal fistula is a severe pathology, which is notable for the difficulty of its surgical treatment. Optimization of treatment approach during rectovaginal fistulas is one of the main objectives of modern proctology.

Materials and methods. We have developed and introduced an algorithm of diagnostic and treatment measures based on the investigation and treatment of 60 patients with rectovaginal fistulas.

During the investigation of patients the attention shall be paid to the state of the pelvic floor muscles, specially levators. In case of separation of levators, the operation of the elimination of the fistula shall be followed by levatoroplastics (4 patients), in case of anal incontinence - by sphincter plastic surgery (3 patients), in case of separation of levator muscles and insufficiency of the sphincter of the anal canal – by sphincter-and- levatoroplastics (18 patients). In case of rectovaginal fistula combined with proctologic diseases, it would be reasonable to correct them before or during operation. Female patients with anal fissures (7 patients) and rectal fistulas (9 patients) during the operation, are exposed to the excision of fissure and removal of pararectal fistula. In patients with hemorrhoidal disease partial hemmorhoidectomy can be carried out (2 patients). Radical hemmorhoidectomy is not suitable.

Results. After the estimation of the number of proctological diseases associated with rectovaginal fistulas, we found out that they are not uncommon and detected in 35 (58%) women. Early and late postoperative periods of all the patients with rectovaginal fistulas combined with anal pathology, which during the operation were exposed to the correction of anorectal diseases, were favorable.

Summary. The developed algorithm of diagnostic and treatment measures in rectovaginal fistulas, covers an individual approach to the selection of the scope of operations for each female patient, by taking into consideration the state of the pelvic floor muscles, rectal obturator and concomitant anorectal diseases.

Date: 2014-12-28; view: 745