A case of recto-vaginal obstetrical fistula treated by the Martius lamp, seen at Befelatanana Madagascar

The rectovaginal fistulas are a pathological epithelialized communication between the vagina and the rectum, its frequency is 10 to 30%, and it is a disabling pathology because of the social repercussion. Many flap techniques have been described but the aim is to present a simple procedure according to a particular technique called Martius. This is a case of woman presenting a low rectovaginal fistula on obstetrical trauma. The surgical technique consists of a repair according to the technique of Martius. The operative follow-up was simple and the patient was able to resume sexual activity and normal anal sphincter function. It is a simple technique, easy to achieve for the technical platform in Madagascar whose evaluation of the results for a larger population should be considered. This technique therefore deserves to be known and widely used.

Interposición de músculo gracilis para reparar fístulas ano y rectovaginales recurrentes / Transposition of gracilis muscle for treatment of recurrent anal and rectovaginal fistula

Introducción: La fistula rectovaginal por definición es la que comunica la región anorrectal hacia la pared posterior de la vagina, como resultado de enfermedad inflamatoria intestinal, lesión iatrogénica, malignidad y trauma. El tratamiento depende de la clasificación de la fístula (simple o compleja). Existen a la fecha pocas publicaciones acerca del uso de la interposición del músculo gracilis como tratamiento factible y seguro para las fístulas rectales, vaginales y uretrales. Casos clínicos: En este artículo presentamos la experiencia inicial en tres pacientes a quienes se les realizó interposición del músculo gracilis, en el Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, centro médico de tercer nivel en la ciudad de México. Conclusiones: El uso de músculo gracilis para reparar fístulas rectovaginales y anorrectales complejas es aplicable en nuestro medio si bien debe limitarse a fístulas recurrentes, después de haber fracasado con otros procedimientos.

BACKGROUND: Rectovaginal fistula is defined as a result of an abnormal connection between the rectum and vagina. It is often a result of inflammatory bowel disease, iatrogenic illness, malignancy or trauma. Rectovaginal fistula treatment is dependent on the classification of the fistula (simple or complex). There are few reports on transposition of gracilis muscle as a feasible option for treatment of rectal, vaginal and urethral fistula. CLINICAL CASES: We present the first three case experiences from the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran," a tertiary-care medical center in Mexico City. CONCLUSIONS: Gracilis muscle transposition is a feasible procedure in our population for treatment of recurrent rectovaginal and anorectal fistulas.