Surgical treatment of rectovaginal fistulas in Crohn's disease: value of vaginal flap: P028

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Aim:The treatment of recto-vaginal fistula (RVF) in the setting of crohn's disease (CD) is based on rectal flap advancement. However, this approach is impossible inpresence of rectal fibrosis, mucosa inflammation, or anal stenosis. Vaginal flap has been reported as an effective alternative. The aim of thepresent study was to report the results of vaginal approach on continence and sexual activity.Methods:Between 2004 and 2008, all patientspresenting with RVF of CD for whom rectal flap was impossible received a vaginal flap. Follow-up examinations were performed at 1, 3 months, and every 3 months for 1 year. Fecal continence was assessed by Wexner's score and sexual activity by Perianal Disease Activity Index.Results:Five patients (mean age 51.6 years) were studied. At 6 months, 4 patients were healed. At 7 months, one patientpresented a new flare up of CD with reopening of the fistula. The other three patients were still healed at a median follow up of 30.6 months. No patient had fecal incontinence. One patientpresented transient postoperative dyspareunia during 3 months.Conclusion:Vaginal flap seems to be effective for the treatment of RVF in CD without entailing neitherprolongated dyspareunia nor anal incontinence.

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