Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistula in Crohn's disease - long term follow-up: LTP52

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Aim:Surgical treatments of recurrent anovaginal or rectovaginal fistula have a high failure rate especially in patients with Crohn's disease. In some patient the perineum or the rectovaginal septum has defects. Graciloplasty has possibly the potential to close recurrent fistulas and to refill soft tissue defects.Method:Over a period of 6 years (2000-2006) 12 patients with recurrent rectovaginal fistulas were treated with graciloplasty. The age ranged from 24 to 47 years, mean age 38 years. Thepresence of Crohn's disease had a mean duration of 12 years. All patients were diverted by a temporary stoma before graciloplasty.Results:In the long term follow-up of median 5 years recurrent anovaginal or rectovaginal fistulas were closed in 10 of 12 patients (83%). Two of the 12 ileostomies were not closed due to persistent fistulas. Two patients had a second operation, one to close a persistant fistula and one to close a additional fistula. A positive effect of the graciloplasty was the reconstruction of the perineal or vaginal defect.Conclusion:Gracilis transposition in the treatment of recurrent anovaginal an rectovaginal fistulas in patients with Crohn's disease has excellent long-term results and can be recommended in selected patients.

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