Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer

Journal of Surgical Oncology
P H Sugarbaker

Abstract

Low anastomosis using a circular stapling instrument has become standard for performing a colorectal reconstruction following resection of a rectal cancer. Often these anastomoses are performed deep in the pelvis using a circular stapling instrument without clear visualization of the anastomotic site. In the female patient, unless an adequate stump of rectum is left above the circular staple line, there is danger that the side wall of the posterior aspect of the vagina can be included in the tissue rings (donuts) that are resected by the circular stapling instrument. This leaves the patient at high risk for late development of a rectovaginal fistula by vaginal mucosa being incorporated into the rectal wall. Maintenance of an adequate mucosa beyond the linear staple linen and a vaginal examination prior to firing the circular stapler will prevent this problem. A patient is presented and the technical details for a safe low-low colorectal anastomosis are reviewed.

References

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Citations

Nov 16, 2005·World Journal of Surgical Oncology·Zhongshu Yan, Guoqing Liao
Jan 1, 1999·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland· Shibata Miyashita
Mar 3, 2010·Journal of the American College of Surgeons·Anaeze C OffodileTracey D Arnell
Aug 8, 2015·International Journal of Colorectal Disease·Jun WatanabeItaru Endo
May 25, 2016·Indian Journal of Surgical Oncology·Vishwas PaiAvanish Saklani
Feb 18, 2009·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·P MatthiessenJ Rutegård
Jan 16, 2015·International Journal of Surgery Case Reports·Milcho PanovskiVasilcho Spirov
Sep 8, 2017·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Maja J PavlovPaul H Sugarbaker
Sep 12, 2019·Annals of Surgical Treatment and Research·In Teak WooHee Jae Lee
Nov 11, 2011·World Journal of Surgery·B DauserF Herbst
May 11, 2018·International Journal of Colorectal Disease·Andrea BallaPierpaolo Sileri

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