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Session: Ongoing Videos

VM76 - Treatment of High Rectovaginal Fistula in an Irradiated Patient Using the TEO Platform: A Video Vignette

ONGOING VIDEOS
Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Aras Emre Canda

    Co-owner
    KRC Private Clinic for Colorectal Surgery and Peritoneal Carcinomatosis
    Izmir, Izmir, Turkey

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • CT

    Cem Terzi, n/a

    Co-owner
    KRC Private Clinic for Colorectal Surgery and Peritoneal Carcinomatosis
    Izmir, Izmir, Turkey

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Aras Emre Canda: This individual has no financial relationships with ineligible companies.
Cem Terzi, n/a: This individual has no financial relationships with ineligible companies.
Purpose/Background: The surgical treatment of rectovaginal fistulas (RVFs) is particularly challenging due to the absence of a universally accepted standard procedure. We present the case of a high rectovaginal fistula repair in a patient with a history of surgery and radiation therapy for endometrial cancer, successfully treated using the Transanal Endoscopic Operation (TEO) platform, with an accompanying educational video outlining the procedure.

Methods/Interventions: A 65-year-old female patient developed a high rectovaginal fistula following radiation therapy and surgery for endometrial cancer seven years prior. After the fistula developed, she underwent a diverting colostomy and had been living with it for approximately one year. Upon physical examination, the fistula was located close to the vaginal cuff. Using the TEO platform, we performed a transanal repair. The patient was positioned in the knee-elbow posture, and the TEO platform was inserted transanally to access the fistula. Scar tissue on the anterior rectal and posterior vaginal walls was excised, and the fistulous tract was completely removed. Both the vaginal and rectal walls were sutured with barbed sutures, which facilitated tension and knot management. The technical details of the surgery are explained in the accompanying video.

Results/Outcomes: The postoperative period was uneventful, and the patient was discharged the day after surgery. The colostomy was reversed two months later after a flexible sigmoidoscopy confirmed the integrity of the rectal lumen. She remained asymptomatic during a one-year follow-up, and a phone consultation three years later confirmed her continued well-being.

Conclusion/Discussion: Reports in the literature on TES for rectovaginal fistulas are limited, and data regarding its success rates remain inconclusive. This case highlights the potential effectiveness of TES using the TEO platform, particularly in patients with a history of radiation therapy. TES with the TEO platform offers a minimally invasive and effective solution for repairing high rectovaginal fistulas. This method is especially suitable for surgeons experienced in TES and offers a straightforward, less invasive alternative for recurrent RVF cases.

Figure
The patient was positioned in the knee-elbow posture, allowing the transanal endoscopic operation (TEO) platform to be inserted transanally, providing direct access to the high rectovaginal fistula site for repair