Evangelista, Eric V. Endorectal advancement flap with muscular plication: a modified technique for rectovaginal fistula repair. By V.

de Paredes, Z. Dahmani, P. Blanchard, J. D Zeitoun, S. Sultan and P. Atienza I. Introduction Acquired rectovaginal fistula is rare. It is due to various conditions, including obstetric injury, inflammatory bowel disease, irradiation, neoplasia or accidental injury. Spontaneous healing is rare, and treatment is usually necessary because of impairment of quality of life. Surgery is the only effective treatment, but the choice of technique is controversial because there is no uniformly successful treatment. The choice depends on the surgeon's expertise, the type of fistula and the state of the anal sphincter. The aim was to improve the technique by using additional muscular procedure identifying factors that may predict success. II. Research Design the researchers used statistical analysis using STATA 9.0. Descriptive analysis reported continuous data as means and categorical data as the number of observation and ratios or proportions. III. Subjects Inclusions Criteria a. Patients with rectovaginal fistula who underwent this modified technique were reviewed. Exclusion Criteria b. Patients with Crohn's disease with proctitis, malignant or radiation related fistula, stricture of the anorectum or those with an external sphincter defect. Sampling Method c. Heterogenous sampling was utilized in the study. IV. Methodology Patients were included who had an acquired rectovatinal fistula. Exclusions included patients with Crohn's disease with proctitis, malignant or radiation related fistula, stricture of the anorectum or those with an external sphincter defect. Surgery included closure of the internal opening with a figure eight reabsorbable suture, plication of the anorectal muscular layer and mucosal flap advancement. Total parenteral nutrition was administered post operatively for seven days. V. Findings The goal of the researchers was to create a second layer of well vascularized tissue, incorporating a greater thickness of healthy tissue under the flap. The technique obtained a success rate of 65%. Rectovaginal fistula is a surgical challenge because wound healing can be impaired by a limited blood supply, the pressure in the distal rectum and anal canal scarring, and inflamed tissue because of secondary infection, and or inflammatory disease. Moreover, the success rate of 65% compares favorably with other published results of the endorectal flap procedure. This procedure resulted with above average outcome show a great deal of promise because it was easy to perform and was without significant complications. Thus, the technique could be a valuable alternative for repair of rectovaginal fistula.