Martius Flap for Rectovaginal Fistula Repair: Operative Technique and Postoperative Outcomes

Abstract

ABSTRACT Purpose: The most common reason for rectovaginal fistula (RVF) is obstetric trauma and the other most common cause is Crohn’s disease (CD). Various surgical options, including sphincteroplasty, gracilis flaps, Martius flaps, fecal diversion and advancement flaps are discussed. The aim of this study is to present the techniques of Martius flap and present patients’ long-term surgical outcomes, quality of life and sexual activity. Methods: A total of six patients with RVF who underwent Martius flap procedure were included in this study. Patient demographics, perioperative outcomes, short and long-term results including quality of life (QOL), sexual function and complications were evaluated. Results: Between April 2014 and August 2014 six female patients with RVF underwent Martius flap procedure. Mean age and body mass index were 47±14.17 (range, 33-68) and 25 (range, 20-36), respectively. The indications for operation were Crohn’s disease (n=3), obstetrical trauma (n=1) and postsurgical complications including stapler misfire (n=1) and rectocele repair (n=1). The mean follow up was 32± 1.47 (range, 3-34) months. Cosmetic outcomes were good for all patients. As the result of the Female Sexual Function Index (FSFI), 66% (n=4) of patients have an active sexual life. QOL is well for all patients. The CGQL score was 0.8. Five patients are followed without recurrence but a patient with CD has recurrence at 18 mo. of operation. Conclusion: Considering the aforementioned advantages, the Martius flap is a feasible technique for RVF repair when performed selectively by experienced hands