Transvaginal repair of pouch-vaginal fistula

Background: The results of surgery for ileoanal pouch-vaginal fistula have been disappointing. Intra-anal procedures result in fistula healing in, at best, approximately 50 per cent of patients. A transvaginal approach was de veloped to achieve direct access to the internal opening, enabling closure without damage to the anal sphincter. Methods: Fourteen patients were treated between January 1992 and December 1 998. All had had restorative proctocolectomy for ulcerative colitis and all were defunctioned. Histological review confirmed the diagnosis in all pati ents. Results: Median age was 40 (range 25-52) years. Median follow-up was 18 (ra nge 6-60) months. The operation was successful in 11 of the 14 patients, af ter one attempt in six patients, after two attempts in four, and after thre e attempts in one patient. The operation failed in three patients, who had a permanent ileostomy. The number of bowel actions in the patients who had successful closure ranged from 2 to 10 (median 6) in 24 h, with no faecal i ncontinence reported. Conclusion: This simple technique achieved healing in 11 of 14 patients. Th is compares favourably with the poor results in 28 patients treated by othe r procedures in the same hospital, with certain healing in five and definit e failure in 20.