ABSTRACT
Objective To investigate the surgical strategy of recurrent rectuvaginal fistula. Methods Retrospectivly analyzed the clinical data of 13 patients with recurrent rectovaginal fistula from December 2001 to December 2008. The etiopathogenisis and the ways of treatment were analyzed. Results All the 13 patients with a transverse colostomy surgical repaired with Mason operation in the secondary intention,and recepted closure of colostomy in the third intention for treatment, all patients were cured. No recurrent fistula was identified with postoperative follow-up 4 - 84 months. Conclusions After recurrent rectovaginal fistula with multiple surgical treatment,the blood supply of local tissue is poor,the scar is serious. Selecting the appropriate timing of operation, adequate preoperative preparation, the application of transverse colostomy and Mason operation in different period could significantly enhance the successful operation rate.
ABSTRACT
PURPOSE: The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers. METHODS: From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively. RESULTS: The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%). CONCLUSION: The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.