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Tracy L. Hull - One of the best experts on this subject based on the ideXlab platform.

  • treatment strategies in crohn s associated Rectovaginal Fistula
    Clinics in Colon and Rectal Surgery, 2019
    Co-Authors: Michelle F Deleon, Tracy L. Hull
    Abstract:

    Rectovaginal Fistula (RVF) is a rare, but dreaded complication of Crohn's disease (CD) that is exceedingly difficult to manage. Treatment algorithms range from observation and medical therapy to local surgical repair and proctectomy. The multitude of surgical options and lack of consensus between experts speak to the complexity and shortcomings encountered to correct this disease process surgically. The key to successful management of these Fistulae therefore rests on a multidisciplinary approach between the patient, gastroenterologists, and surgeons, with open communication about expectations and goals of care. In this article, we review the management of CD-associated RVF with an emphasis on surgical technique.

  • should immunomodulation therapy alter the surgical management in patients with Rectovaginal Fistula and crohn s disease
    Diseases of The Colon & Rectum, 2016
    Co-Authors: Rahul Narang, Tracy L. Hull, Steven Perrins, Jose Sebastian Garcia, Steven D Wexner
    Abstract:

    Background Rectovaginal Fistula in Crohn's disease is challenging for both healthcare providers and patients. The impact of immunomodulation therapy on healing after surgery is unclear. Objective The purpose of this study was to examine whether immunomodulation therapy impacts healing after surgery for Rectovaginal Fistula in Crohn's disease. Design This was a retrospective analysis with a follow-up telephone survey. Settings The study was conducted at two major tertiary referral centers. Patients All of the patients who underwent Rectovaginal Fistula repair from 1997 to 2013 at our centers were included. Main outcome measures A χ test and logistical regression analysis were used to study treatment outcomes according to type of procedure, recent use of immunosuppressives, and number of previous attempted repairs. Age, BMI, smoking, comorbidities, previous vaginal delivery/obstetric injury, use of probiotics, diverting stoma, and use of seton were also analyzed. Results A total of 120 (62%) patients were contacted, and 99 (51%) of them agreed to participate in the study. Mean follow-up after surgical repair was 39 months. Procedures included advancement flap (n = 59), transvaginal repair (n = 14), muscle interposition (n = 14), episioproctotomy (n = 6), sphincteroplasty (n = 3), and other (n = 3); overall, 63% of patients experienced healing. Sixty-eight patients underwent recent immunomodulation therapy but did not exhibit statistical significance in outcome after surgical repair. In the subset of patients with Fistula related to obstetric injury, a 74% (n = 26) healing rate after surgical repair was observed. Age, BMI, diabetes mellitus, use of steroids, probiotics, seton before repair, fecal diversion, and number of repairs did not affect healing. Limitations This was a retrospective analysis; the high volume tertiary referral inflammatory bowel disease centers studied may not be reflective of Rectovaginal Fistula presentation, treatment, or results in all patients, and the 3-year follow-up may not be sufficiently long. Conclusions Despite a relatively low success rate (63%) in healing after surgical repair of a Rectovaginal Fistula, the recent use of immunomodulation therapy did not negatively impact healing. However, tissue interposition techniques had the highest success rates.

  • contemporary surgical management of Rectovaginal Fistula in crohn s disease
    World Journal of Gastrointestinal Pathophysiology, 2014
    Co-Authors: Michael A Valente, Tracy L. Hull
    Abstract:

    Rectovaginal Fistula is a disastrous complication of Crohn’s disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women’s quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various Fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated Rectovaginal Fistula.

  • Current considerations in the management of Rectovaginal Fistula from Crohn's disease.
    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2008
    Co-Authors: C. D. Hannaway, Tracy L. Hull
    Abstract:

    Rectovaginal Fistulas are dreaded complications of Crohn's disease. Accurate assessment is essential for planning management. Treatment options range from observation to medical therapeutics to the need for surgical intervention. Ultimately, establishing reasonable expectations is mandatory when treatment algorithms are considered. In this article, we review the evaluation of these Fistulas and the current options to consider in the treatment of Crohn's related Rectovaginal Fistula.

  • Success of Episioproctotomy for Cloaca and Rectovaginal Fistula
    Diseases of The Colon & Rectum, 2006
    Co-Authors: Tracy L. Hull, C. Bartus, Jane Bast, Crina Floruta, Rocio Lopez
    Abstract:

    Surgical repair of Rectovaginal Fistula with an advancement flap has had suboptimal results. The existing literature documenting episioproctotomy as a surgical option in females with Rectovaginal Fistula or cloaca is limited. This study was designed to examine our experience with episioproctotomy in this group. Additionally we were interested in risk factors, which might predict failure. All females who had repair of a Rectovaginal Fistula or cloaca with episioproctotomy from 1998 to 2004 were studied. Data were collected from chart review and telephone contact. This included demographics, body mass index, tobacco use, Crohn’s disease, previous surgery, and diverting stoma. Data were obtained from 42 females (mean age, 39.2 (range, 25–70) years). The mean follow-up was 37 (range, 2–84) months. Nine females had a cloaca and the rest had a Rectovaginal Fistula with an anterior sphincter defect. Eleven (all with anterior tissue) had recurrence of Fistula. None with cloaca had recurrence. Eight of 11 recurrences occurred in females who had failed at least one previous repair. No variables that were studied significantly affected recurrence. Median (25th, 75th percentiles) postoperative Wexner incontinence scores for those with and without recurrence were 8 (7, 12) and 5 (2, 6) respectively. Episioproctotomy is a successful technique for repair of Rectovaginal Fistula and cloaca. Incontinence score postoperatively were acceptable. It should be considered a first line of surgical treatment in those with a Fistula that includes compromise of the anterior sphincter complex.

Steven D Wexner - One of the best experts on this subject based on the ideXlab platform.

  • should immunomodulation therapy alter the surgical management in patients with Rectovaginal Fistula and crohn s disease
    Diseases of The Colon & Rectum, 2016
    Co-Authors: Rahul Narang, Tracy L. Hull, Steven Perrins, Jose Sebastian Garcia, Steven D Wexner
    Abstract:

    Background Rectovaginal Fistula in Crohn's disease is challenging for both healthcare providers and patients. The impact of immunomodulation therapy on healing after surgery is unclear. Objective The purpose of this study was to examine whether immunomodulation therapy impacts healing after surgery for Rectovaginal Fistula in Crohn's disease. Design This was a retrospective analysis with a follow-up telephone survey. Settings The study was conducted at two major tertiary referral centers. Patients All of the patients who underwent Rectovaginal Fistula repair from 1997 to 2013 at our centers were included. Main outcome measures A χ test and logistical regression analysis were used to study treatment outcomes according to type of procedure, recent use of immunosuppressives, and number of previous attempted repairs. Age, BMI, smoking, comorbidities, previous vaginal delivery/obstetric injury, use of probiotics, diverting stoma, and use of seton were also analyzed. Results A total of 120 (62%) patients were contacted, and 99 (51%) of them agreed to participate in the study. Mean follow-up after surgical repair was 39 months. Procedures included advancement flap (n = 59), transvaginal repair (n = 14), muscle interposition (n = 14), episioproctotomy (n = 6), sphincteroplasty (n = 3), and other (n = 3); overall, 63% of patients experienced healing. Sixty-eight patients underwent recent immunomodulation therapy but did not exhibit statistical significance in outcome after surgical repair. In the subset of patients with Fistula related to obstetric injury, a 74% (n = 26) healing rate after surgical repair was observed. Age, BMI, diabetes mellitus, use of steroids, probiotics, seton before repair, fecal diversion, and number of repairs did not affect healing. Limitations This was a retrospective analysis; the high volume tertiary referral inflammatory bowel disease centers studied may not be reflective of Rectovaginal Fistula presentation, treatment, or results in all patients, and the 3-year follow-up may not be sufficiently long. Conclusions Despite a relatively low success rate (63%) in healing after surgical repair of a Rectovaginal Fistula, the recent use of immunomodulation therapy did not negatively impact healing. However, tissue interposition techniques had the highest success rates.

  • are there predictors of outcome following Rectovaginal Fistula repair
    Diseases of The Colon & Rectum, 2010
    Co-Authors: Rodrigo Ambar Pinto, Thais V Peterson, Sherief Shawki, Willy G Davila, Steven D Wexner
    Abstract:

    BACKGROUND:Rectovaginal Fistula is a distressing condition for patients and for physicians who are continuously challenged in providing durable treatment options. The aim of this study is to assess the results of Rectovaginal Fistula repair and identify predictive factors for poor outcome.METHODS:Re

R. Scherer - One of the best experts on this subject based on the ideXlab platform.

  • Innovative technique for the closure of Rectovaginal Fistula using Surgisis™ mesh
    Techniques in Coloproctology, 2009
    Co-Authors: O. Schwandner, A. Fuerst, K. Kunstreich, R. Scherer
    Abstract:

    Background The aim of this prospective study was to analyse the efficacy of Surgisis mesh for closure of Rectovaginal Fistulas. Prospective data were collected from two centres. Methods All patients with a Rectovaginal Fistula who underwent definitive surgery using Surgisis mesh were prospectively enrolled in this study. Inclusion criteria included a Rectovaginal Fistula in the lower two-thirds of the Rectovaginal septum. Surgery was performed with a standardized technique including combined transrectal and transvaginal excision of the Rectovaginal Fistula with transvaginal placement of the mesh. Success was defined as closure of both internal and external (perianal and vaginal) openings, absence of drainage without further intervention, and no abscess formation. Results Over a period of 16 months, a total of 21 mesh procedures were performed in two centres. The mean age of the patients was 47 years (18–59 years). Of the 21 patients, 18 (86%) had recurrent Rectovaginal Fistula, and the mean number of prior attempts was 2.3 (0–8). The majority of patients (nine) had Crohn’s disease-associated Fistula, followed by six with iatrogenic Fistula, two with radiation-induced Fistula, two with obstetric injuryinduced Fistula, and two with idiopathic Fistula. The mesh procedure was performed under faecal diversion in eight patients (38%). The mean operative time was 38 min; no intraoperative morbidity occurred. Patients were discharged from hospital on day 4. After a mean follow-up of 12 months (range, 3–18 months), the overall success rate after primary mesh procedure was 71% (15/21; 6 patients had failure or recurrence). All patients with failure or recurrence were reoperated upon. Out of these six patients who were reoperated upon, four had definite healing (75%). Among the eight patients who had faecal diversion, four (50%) had reversal of their stoma. Conclusion The preliminary success rate for this innovative technique using Surgisis mesh for the closure of Rectovaginal Fistulas is promising. Further studies are needed to assess the definite role of this novel technique in comparison to traditional surgical procedures

Hidetoshi Katsuno - One of the best experts on this subject based on the ideXlab platform.

  • Successful repair of a Rectovaginal Fistula caused by a tension-free vaginal mesh (TVM): a case report
    The Japan Society of Coloproctology, 2018
    Co-Authors: Yoshikazu Koide, Kotaro Maeda, Tsunekazu Hanai, Koji Masumori, Hiroshi Matuoka, Hidetoshi Katsuno, Tomoyoshi Endo, Miho Shiota, Masahiro Mizuno, Yeong Cheol Cheong
    Abstract:

    Rectovaginal Fistula caused by a tension-free vaginal mesh (TVM) is a rare condition. Moreover, a Rectovaginal Fistula is a challenging issue to address for surgeons regardless of causes. Due to a low rate of occurrence, treatment modality for a Rectovaginal Fistula caused by a TVM has previously received little attention. A successful surgery using several key techniques to address a Rectovaginal Fistula caused by a TVM is herein reported. A 78-year-old woman who underwent a TVM for a rectocele three months ago was referred to our hospital with a two-month history of anal bleeding. Mesh protruding into both the vagina and the rectum was confirmed. The patient was operated on under diagnosis of a Rectovaginal Fistula caused by TVM. TVM was removed by transvaginal dissection of the Rectovaginal septum with division of both anterior and posterior arms of the TVM. Layer-to-layer sutures of rectal and vaginal walls were crossly performed with a drain placed in the Rectovaginal septum after saline irrigation followed by a covering sigmoid colostomy. The wound healed without infection after surgery, and a water-soluble contrast enema demonstrated the healing of the Rectovaginal Fistula two months after surgery. No recurrent Fistula was confirmed 15 months after stoma closure

  • the long term outcome of transvaginal anterior levatorplasty for intractable Rectovaginal Fistula
    Colorectal Disease, 2015
    Co-Authors: K Maeda, Tsunekazu Hanai, Y Koide, Harunobu Sato, K Masumori, Hiroshi Matsuoka, Hidetoshi Katsuno
    Abstract:

    AIM Several procedures have been described for Rectovaginal Fistula with a wide range of success, but there is little information on the long-term outcome. The aim of the present study was to investigate the long-term outcome after transvaginal anterior levatorplasty (ALP) for intractable Rectovaginal Fistula. METHOD Data of 16 consecutive patients undergoing transvaginal ALP with fistulectomy and closure of the rectum and vagina between 1998 and 2011 were prospectively recorded and retrospectively investigated to study the long-term outcome. RESULTS Birth injury (n = 7), low anterior resection for rectal cancer (n = 3), pouch surgery for ulcerative colitis (n = 2) and a procedure for prolapse and haemorrhoids (n = 2) were the main causes of the Fistula. Nine patients had a covering stoma before surgery. All patients underwent ALP, with a covering stoma in two patients. Infection occurred in one patient and wound rupture after surgery in another patient. These patients underwent reoperation by ALP. All Fistulae had healed at a median follow-up of 84 (8-193) months after initial surgery or stoma closure. CONCLUSION Transvaginal ALP is effective for the treatment of mid or low Rectovaginal Fistula. The results show that a graft is not necessary regardless of whether or not previous surgery has been performed.

Ron G. Shashy - One of the best experts on this subject based on the ideXlab platform.

  • Lymphogranuloma venereum presenting as a Rectovaginal Fistula.
    Infectious diseases in obstetrics and gynecology, 1999
    Co-Authors: Catherine M. Lynch, T. L. Felder, R. A. Schwandt, Ron G. Shashy
    Abstract:

    Lymphogranuloma venereum (LGV) is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world's literature, there has not been a case reported in the last thirty years of a case of LGV presenting as a Rectovaginal Fistula. We present a case of an otherwise healthy American woman who presented with a Rectovaginal Fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage.

  • Lymphogranuloma Venereum Presenting as a Rectovaginal Fistula
    Infectious Diseases in Obstetrics and Gynecology, 1999
    Co-Authors: Catherine M. Lynch, T. L. Felder, R. A. Schwandt, Ron G. Shashy
    Abstract:

    Lymphogranuloma venereum (LGV) is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world’s literature, there has not been a case reported in the last thirty years of a case ofLGV presenting as a Rectovaginal Fistula. We present a case of an otherwise healthy American woman who presented with a Rectovaginal Fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage. Infect. Dis. Obstet. Gynecol. 7:199–201, 1999