World Journal of Laparoscopic Surgery

Register      Login

VOLUME 17 , ISSUE 2 ( May-August, 2024 ) > List of Articles

Original Article

Management of Malignant Vaginal Fistulas: Suggestion of a Novel Technique

Ghodratollah Maddah, Ali Mehri, Abbas Abdollahi, Mohammad Etezad Pour, Mohammad Taghi Rajabi Mashhadi

Keywords : New technique, Outcomes, Pelvic malignancy, Vaginal fistula

Citation Information : Maddah G, Mehri A, Abdollahi A, Pour ME, Mashhadi MT. Management of Malignant Vaginal Fistulas: Suggestion of a Novel Technique. World J Lap Surg 2024; 17 (2):65-68.

DOI: 10.5005/jp-journals-10033-1547

License: CC BY-NC 4.0

Published Online: 18-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Objective: This study was performed with the aim to evaluate the results of the treatment of vaginal fistulas caused by pelvic malignancy and to present a new surgical technique. Materials and methods: In this retrospective study, patients with vaginal fistula who have been treated in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences from 2004 to 2020 were studied. The inclusion criteria were the patients whose fistulas were caused by malignant neoplasia with pelvic organ origin. The patients with fistulas caused by other causes were excluded from the study. Patients’ information was collected from the electronic records and the hospital archives and also the information recorded by the surgeon. Results: Out of 26 patients with vaginal fistula caused by pelvic malignancies, 18 cases had enterovaginal fistula. Cancer of cervix (11 cases) was the most prevalent cancer. Time interval between the incidence of fistula and the onset of the disease was 43.5 months. About 16 patients had a history of radiotherapy before the onset of the fistula, and 23 cases had undergone surgery before the onset of fistula. About 11 patients were treated with resection, 8 patients with ostomy, and 5 with fistulized loop bypass. Discussion and conclusion: In cases of extensive pelvic involvement with a tumor, it is recommended to use intestinal bypass in fistula site with the technique provided in this article, since it controls the symptoms of the patient and has limited complications.

PDF Share
  1. Tsang CB, Rothenberger DA. Rectovaginal fistulas: Therapeutic options. Surg Clin North Am 1997;77(1):95–114. DOI: 10.1016/s0039-6109(05)70535-1.
  2. Forsgren C, Altman D. Risk of pelvic organ fistula in patients undergoing hysterectomy. Curr Opin Obstet Gynecol 2010;22(5): 404–407. DOI: 10.1097/GCO.0b013e32833e49b0.
  3. Narayanan P, Nobbenhuis M, Reynolds KM, et al. Fistulas in malignant gynecologic disease: Etiology, imaging, and management. Radiographics 2009;29(4):1073–1083. DOI: 10.1148/rg.294085223.
  4. Berek JS, Howe C, Lagasse LD, et al. Pelvic exenteration for recurrent gynecologic malignancy: Survival and morbidity analysis of the 45-year experience at UCLA. Gynecol Oncol 2005;99(1):153–159. DOI: 10.1016/j.ygyno.2005.05.034.
  5. García del Salto L, de Miguel Criado J, Aguilera del Hoyo LF, et al. MR imaging-based assessment of the female pelvic floor. Radiographics 2014;34(5):1417–1439. DOI: 10.1148/rg.345140137.
  6. Davits R, Miranda S. Conservative treatment of vesicovaginal fistulas by bladder drainage alone. Br J Urol 1991;68(2):155–156. DOI: 10.1111/j.1464-410x.1991.tb15285.x.
  7. Zhu Y-F, Tao G-Q, Zhou N, et al. Current treatment of rectovaginal fistula in Crohn's disease. World J Gastroenterol 2011;17(8):963–967. DOI: 10.3748/wjg.v17.i8.963.
  8. Kılıçkesmez Ö, Andıç Ç, Oğuzkurt L. Delayed failure of rectovaginal fistula embolization with Amplatzer vascular plug 2. Diagn Interv Radiol 2014;20(6):511–512. DOI: 10.5152/dir.2013.14177.
  9. Emmert C, Köhler U. Management of genital fistulas in patients with cervical cancer. Arch Gynecol Obstet 1996;259(1):19–24. DOI: 10.1007/BF02505304.
  10. Ommer A, Herold A, Berg E, et al. German S3-guideline: Rectovaginal fistula. Ger Med Sc 2012;10. DOI: 10.3205/000166.
  11. Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center. Urol J 2010;7(1):35–39. PMID: 20209454.
  12. Zelga P, Tchórzewski M, Zelga M, et al. Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies – New patients, old problem? Langenbecks Arch Surg 2017;402(7): 1079–1088. DOI: 10.1007/s00423-016-1539-4.
  13. Takano S, Boutros M, Wexner SD. Gracilis muscle transposition for complex perineal fistulas and sinuses: A systematic literature review of surgical outcomes. J Am Coll Surg 2014;219(2):313–323. DOI: 10.1016/j.jamcollsurg.2014.04.006.
  14. Lalwani S, Varma V, Kumaran V, et al. Complex rectovaginal fistula – An experience at a tertiary care centre. Indian J Surg 2015;77(Suppl 3):1142–1147. DOI: 10.1007/s12262-015-1218-7.
  15. van der Hagen SJ, Soeters PB, Baeten CG, et al. Laparoscopic fistula excision and omentoplasty for high rectovaginal fistulas: A prospective study of 40 patients. Int J Colorectal Dis 2011;26(11): 1463–1467. DOI: 10.1007/s00384-011-1259-8.
  16. Schloericke E, Zimmermann M, Benecke C, et al. Surgical management of complicated rectovaginal fistulas and the role of omentoplasty. Tech Coloproctol 2017;21(12):945–952. DOI: 10.1007/s10151-017-1657-1.
  17. Bohoussou E, Dia JM, Okon G, et al. Results of the management of urogenital fistulae from community caravans. Open J Obstet Gynecol 2017;7(8):858. DOI: 10.4236/ojog.2017.78086.
  18. Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 2003;48(3):295–304. DOI: 10.1016/s1040-8428(03)00123-9.
  19. Urbano-Ruiz A, Soares J Jr, da Motta E, et al. When to perform palliative surgery in the treatment of ovarian cancer: A brief review. Eur J of Gynaecol Oncol 2013;34(6):532–534. PMID: 24601045.
  20. Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum 1995;38(1):4–6. DOI: 10.1007/BF02053849.
  21. Tozer P, Balmforth D, Kayani B, et al. Surgical management of rectovaginal fistula in a tertiary referral centre: Many techniques are needed. Colorectal Dis 2013;15(7):871–877. DOI: 10.1111/codi.12114.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.