Novel surgical repair with bilateralgluteus muscle patching for intractable rectovaginalfistula

Abstract. We created a novel surgical repair for intractablerectovaginal fistula and treated four patients who hadpreviously undergone unsuccessful surgery. An X-shaped skinincision was made on the perineum, and then the rectum wascarefully divided from the vagina. Defects of both the rectumand the vagina were closed with vertical mattress sutures. Theexternal sphincter muscle also was approximated. The gluteusmuscle was identified through another skin incision to thebuttock, and cut at the attachment to the femur. Bilateralgluteus muscles were approximated at the midline of the perineumso that the vagina was sufficiently separated from the rectum.Established anorectal angle was 92.5° (SD=6.4°). Mean restingpressure was 101.3 cm H₂O (SD=13.1). Allpatients retained complete anal function without soiling. Theunusual problem of erosion of the posterior vaginal wall withfistulation in a sexually active woman justifies greaterefforts, and this surgical technique offers good prospects inthis small group of patients.