Imperial College London
Alternate

Professor Jamie Murphy BChir PhD FRCS FASCRS - Consultant Colorectal Surgeon

Faculty of Medicine, Department of Surgery & Cancer

Visiting Professor
 
 
 
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Contact

 

jamie.murphy

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{de:2018:10.1097/DCR.0000000000000980,
author = {de, Bruijn H and Maeda, Y and Murphy, J and Warusavitarne, J and Vaizey, CJ},
doi = {10.1097/DCR.0000000000000980},
journal = {Diseases of the Colon and Rectum},
pages = {140--143},
title = {Combined Laparoscopic and Perineal Approach to Omental Interposition Repair of Complex Rectovaginal Fistula},
url = {http://dx.doi.org/10.1097/DCR.0000000000000980},
volume = {61},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - INTRODUCTION:Surgical repair of rectovaginal fistula remains a challenge. Complex and recurrent rectovaginal fistula repairs often fail because of scarring and devascularization of the surrounding tissue. Omental interposition may promote healing by introducing bulky vascularized tissue into the rectovaginal septum.TECHNIQUE:With the patient in the lithotomy position, the rectovaginal septum was dissected transperineally up to the fistula tract and the openings on both vaginal and rectal sides were closed using interrupted, absorbable sutures. The dissection was continued cranially to meet the laparoscopic dissection from above. The laparoscopic surgeon detached the omentum from the colon, then the anastomotic arterial branches between the Barlow’s arcade and the gastroepiploic arcade were divided and the greater omentum was mobilized, retaining blood supply from the left gastroepiploic artery. The rectum was then mobilized commencing on the right lateral side of the mesorectum and then proceeding anteriorly. The peritoneum between the rectum and the vagina was incised and the anterior mobilization was continued to connect with the perineal dissection. The mobilized omentum was pulled down between the rectum and the vagina.TECHNIQUE:The perineal operator secured the omentum around the rectal closure and at skin level with absorbable sutures. All of the patients had a defunctioning ileostomy or colostomy before omental repair.RESULTS:Patients underwent repair for complex or recurrent rectovaginal fistulas with this novel approach. Fistula healing was evaluated during examination under anaesthesia. All of the patients had completely healed at the latest follow-up (median = 15 mo; range, 8–41 mo). Postoperative complications included 1 superficial wound infection that was treated conservatively and 1 rectovaginal hematoma, which required CT-guided aspiration.CONCLUSIONS:Combined laparoscopic omental interposition with perineal rectovaginal fistula repair is
AU  - de,Bruijn H
AU  - Maeda,Y
AU  - Murphy,J
AU  - Warusavitarne,J
AU  - Vaizey,CJ
DO  - 10.1097/DCR.0000000000000980
EP  - 143
PY  - 2018///
SN  - 0012-3706
SP  - 140
TI  - Combined Laparoscopic and Perineal Approach to Omental Interposition Repair of Complex Rectovaginal Fistula
T2  - Diseases of the Colon and Rectum
UR  - http://dx.doi.org/10.1097/DCR.0000000000000980
UR  - http://hdl.handle.net/10044/1/56952
VL  - 61
ER  -
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