Przetoki odbytniczo-pochwowe – aktualne postępowanie diagnostyczne i terapeutyczne

*Małgorzata Kołodziejczak¹, Iwona Sudoł-Szopińska¹, Andrzej Maletka²

Streszczenie
Rectovaginal fistula is a chronic and frequently socially embarrassing condition with significant impact on quality of life. It leads to deterioration of quality of life, including, in many cases, its working and sexual aspects. Treatment for rectovaginal fistulas often requires cooperation between gynaecologist, proctologist, and radiologist. This paper describes etiology of these types of fistulas, in particular obstetric trauma, and predisposing risk factors, including: disproportion between fetal mass and lumen of vagina, IIIrd and IVth perineal rupture, instrumental deliveries, midline episiotomy, and infection of post episiotomy wound. Current diagnostic approaches with emphasis on endosonography correlated with manual vaginal examination were discussed. Use of endosonography is especially valuable before treatment of recurrent fistula and in women after obstetric defect of anal sphincters. Precise description of range of defect in patients with a history of anal sphincters tears following vaginal delivery or treatment for anal abscess or fistula command use of sphincters saving operative techniques, at the same time enables prognosis of anal incontinence. Classification of fistulas is presented along with three surgical techniques, including transvaginal, transrectal, and abdominal approaches. High rectovaginal fistulas resulting most frequently from post radiation changes in the rectum were mentioned too, with limited to decompressed colostomy technique of their treatment. This manustript presents also modern attempts of biological treatment for rectovaginal fistulas. Subsequently follows recent literature review and conclusions based on extensive personal experience in the field.

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