Why Low Positioning Is Important
Vaginal-rectal fistula is a pathological communication through which intestinal contents and gases enter the vagina. The condition is difficult to bear physically and psychologically, is accompanied by constant inflammation and sharply limits social life. The level of the fistula location determines the tactics: low fistulas are accessible through vaginal access without opening the abdominal cavity, which makes the operation much less traumatic compared to high ones. The fistula tract is excised, the intestinal and vaginal defects are sutured separately, and a layer of healthy tissue is formed between them. The main causes of such fistulas are birth trauma and complications of rectal surgery.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.