The role and importance of ostomy in the management of recto-vaginal fistula

Abstract

Background: Although rare, recto-vaginal fistulas (RVF), defined as an abnormal epithelial connection between the rectum and vagina, has a significant adverse consequences in terms of the life quality. The most common etiological factors involve the obstetric causes in developing countries, while cancer surgery and radiotherapy are responsible for the majority of the cases in the developed world. The surgical management encompasses a wide range of procedures from simple interventions to more complex ones. Ostomy represents a therapeutic option aimed at achieving infection control through the deportation of the feces away from the site of fistula, allowing tissue repair and preparation prior to definitive repair. A complete diversion of the feces is essential, with no closure of the ostomy until complete healing. Methods: Six patients with RVF referred to the Erol Olçok Training and Research Hospital, Medical Faculty of Hitit University in 2015-2017 were included and their data were evaluated retrospectively. After detailed information provided to patients, written informed consent obtained. Local Ethics committee approved. Demographic data, type of fistula, comorbid conditions, initial and subsequent surgery with their outcomes were reported. Complete blood counts and routine biochemistry tests were also performed before and after ostomy to assess infectious processes. Results: Patient numberone and two had RVF due to RT given for cancer treatment, while patients number four, five and 6 had RVF after cancer surgery. Patient number three had chronic constipation resulting from paraplegia and the subsequent prolonged pressure on the recto-vaginal septum, giving rise to RVF. Permanent Hartmann colostomy was performed in our patients no 1 and 2, due to the presence of comorbid VVF as well as the presence of cervical cancer, while the same procedure was applied in-patient no 2 due to the presence of lung metastases. In-patient no 3, colostomy was not closed at the discretion of the patient, since she was bed-ridden and the temporary colostomy was able to provide better feces control, although RVF healing occurred. In patients, no 4, 5 and 5, RVF spontaneously healed after temporary ileostomy, with subsequent closure of ileostomy. Conclusions: In these patients, temporary or permanent ostomy may be performed to control infections, to manage fecal discharge in bed-ridden or demented patients, and to prevent complications arising from infections and adhesions of intestines after RT depending on the general wellbeing and life expectancy of the patients. Although the decision to choose permanent ostomy is not an easy task for both the patient and physician, it should be performed after adequate consultation with the patient, when needed. © 2017, E-Century Publishing Corporation. All rights reserved.