Clinical Results of Coloanal Anastomosis in Radiation-induced Rectovaginal Fistula

ABSTRACT

PURPOSE: Generally speaking, permanent colostomy has been frequently used as a treatment for radiation-induced rectovaginal fistula. In order to administer an operation accurately, at least two-staged operations have been performed. If anastomosis were to be performed between normal, healthy tissues after removal of irradiation-damaged tissues definite operation could be performed in one stage. We reviewed clinical records to evaluate postoperative recurrence and anal functions in patients who underwent coloanal anastomosis without diverting colostomy as one step due to radiation-induced rectovaginal fistula. METHOD: From Sep. 1994 to Jun. 2000 we did a retrospective study with clinical data of 8 patients who underwent operations due to radiation-induced rectovaginal fistula in Yongdong Severance Hospital. RESULTS: The mean age was 49 years (range 31-61). All patients concurrently received irradiation and induction chemotherapy due to primary, gynecologic malignancies. The total dosage of exposure to radiation was 8,400 cGy in 6 of 8 cases and 8,940 cGy in the remaining 2 cases. TAH with BSO had been undergone before concurrent chemoradiation in 2 cases. The median duration from diagnosis to operation was 29 months (range 16-131) in cases without previous colostomy (n=7) and 7 months in cases with colostom y (n=1). Before the operation, previous surgery had been undergone in 2 cases due to rectovaginal fistula. No recurrences were noted for gynecologic malignancies. The mean distance of fistula opening from anal verge was 3.9 cm (range 2.0-7.0). For 7 out of 8 cases, patients underwent LAR with handsewn coloanal anstomosis and the remaining patient underwent anterior resection. No diverting colostomy was performed for all cases. During the median follow-up period of 25 months (range 7-71), two patients developed anal stenosis. One patient experienced postoperative recurrence for the follow-up period. In terms of sphincter function (n=6) (f/u period>12 months), there were 1 urgency, 1 gas incontinence and 1 night staining. CONCLUSIONS: Although this study is a small scale research in terms of the number of subjects involved, one-staged, handsewn coloanal anastomosis after LAR without colostomy may be proved to be helpful for the patients with radiation-induced rectovaginal fistula. If case selection performed properly, unnecessary operation can be avoided and psychologic resistance can be reduced by this procedure.