RECTO-VAGINAL-FISTULA REPAIR

General Information

DEFINITION--Repair of a fistula (an abnormal tract) between the rectum and vagina that usually results from tearing during childbirth, surgical procedures, cervical cancer, radiation therapy or inflammatory bowel disease.

BODY PARTS INVOLVED--Vagina; rectum; connective tissue; blood vessels and nerves in the perineum.

REASONS FOR SURGERY--Prevention of fecal matter from contaminating the vagina or urinary tract.

SURGICAL RISK INCREASES WITH

• Obesity; smoking.
• Poor nutrition; alcoholism.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--Proctologist or general surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of lower gastrointestinal tract and kidneys.
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the perineum.
• Scar tissue and the fistula between the vagina and rectum are cut free and removed.
• The openings into the rectum and vagina are closed with sutures that will be absorbed by the body.
• With some fistulas, a temporary (2-3 months) colostomy may be necessary (see Colostomy in Surgery section).
• The skin is closed with sutures, which usually may be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Failure to heal completely.

AVERAGE HOSPITAL STAY--5 to 7 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 6 weeks for recovery from surgery.

Postoperative Care

GENERAL MEASURES

• Take hot baths several times a day to relieve discomfort.
• Bathe after bowel movements to prevent infection.
• Use sanitary pads instead of tampons during menstrual periods for 6 months.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 weeks after surgery. Resume sexual relations when your doctor determines that healing is complete. > Resume driving 1 week after returning home.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting, constipation or diarrhea.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.