Hellow guys, Welcome to my website, and you are watching AUA2017 V2-01: Repair of a complex vaginal J-pouch fistula utilizing a gracilis muscle interposition. and this vIdeo is uploaded by AUAUniversity at 2020-04-22T21:00:18-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | AUA2017 V2-01: Repair of a complex vaginal J-pouch fistula utilizing a gracilis muscle interposition |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 23-04-2020 04:00:18 |
| Video Discription | AUA2017 V2-01: Repair of a complex vaginal J-pouch fistula utilizing a gracilis muscle interposition flap For more 2017 Surgical Videos, visit: https://auau.auanet.org/node/9765 For 2018 Surgical Videos, https://auau.auanet.org/node/9628 For 2019 Surgical Videos, visit: https://auau.auanet.org/node/25250 For 2020 Surgical Videos, visit: https://auau.auanet.org/node/28146 INTRODUCTION Rectovaginal and J-pouch vaginal fistulae are abnormal epithelialized connections between the rectum or J-pouch to the vagina. Symptoms, such as fecal incontinence, can be distressing to patients. These fistulae can be a challenge to repair and multiple repair methods have been described in the literature including transvaginal, transrectal, and flap interposition repairs. Success rates in the literature range from 10-100% and with each subsequent repair the success rate of closure decreases. METHODS We present the case of a 35 year-old woman with a history of ulcerative colitis who developed a fistula following a total proctocolectomy and ileal-anal pouch anastomosis. When she presented she had already undergone more than ten attempts at repair. Prior to our fisula repair she had a fecal diversion with a loop ileostomy. We performed a transvaginal repair utilizing a gracilis muscle interposition flap. Indocyanine green was given intravenously and the SPY Elite imaging system was used to enable the visualization of microvascular blood flow and perfusion to the gracilis flap and to the bed of the fistula repair intraoperatively. RESULTS Our patient did well after the procedure. She was discharged home with the foley in place on post-operative day 1. At her one month follow-up the repair was intact and she was healing well. CONCLUSION In cases of complex rectovaginal and vaginal J-pouch fistulae, especially those that are reoperative cases, fistula repair with a gracilis interposition flap is a viable repair option. Success from this repair can be aided by assuring complete excision of non-viable tissue and a healthy flap. In our case these steps were aided by the use of the SPY Elite imaging system. Funding: none |
| Category | Education |
| Tags | AUA | american urological association | AUAU | surgical video | SVL | surgical video library | AUA2017 | robotics | robotic surgery | surgery | urology | urologist | vaginal J-pouch fistula | gracilis muscle interposition flap | gracilis muscle | J-pouch vaginal fistulae | proctocolectomy | female pelvic medicine |
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