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This article discusses different surgical techniques for the treatment of rectovaginal fistula. The video vignette demonstrates two cases: one involving a modified LIFT procedure and the other involving a Martius flap procedure. The choice of technique depends on the anatomical characteristics determined by clinical findings and imaging. The authors conclude that the modified LIFT procedure is the procedure of choice for patients with a linear fistula tract, preserved anatomical muscles, and no previous vaginal delivery, while the Martius flap procedure should be used in cases of recurrence. Both techniques have shown good results. [Extracted from the article]

Aim: The rate of secondary failure after obstetric sphincter injury repair is unknown, with the literature reporting rates ranging from 0.1% to 53%. We aimed to perform an audit to identify the rate and risk factors for failure of sphincter repair in a cohort of postpartum women using endoanal ultrasound (EAUS) and manometry, assessing the risk factors and impact of these events. Method: Prospective data were collected within a 2 year period from patients who attended the perineal clinic at Eastern Health. Variables of primary repair and presence of postpartum complications were recorded and subsequently analysed. Results: Of 239 patients with obstetric anal sphincter injury (OASI) included, 100 (41.8%) had EUAS evidence of sphincter defects. Only 20% with secondary repair failure were symptomatic with faecal or flatal incontinence at a mean follow‐up of 23.4 months postpartum. Patients with secondary repair failure had lower anal resting (p = 0.006) and maximum squeeze pressures compared with patients with intact repairs (p < 0.001). In terms of variables that were investigated, namely location, operator hierarchy, type of repair and material used, none had a statistically significant correlation with secondary repair failure of OASI. Postpartum complications had an overall incidence of 12.7%, and those with any complication were found to have an increased rate of secondary failure of repair (p = 0.157). Conclusion: Using EAUS to confirm secondary failure of repair, incidence was 41.4% in this cohort. There were no identifiable modifiable variables that reduced the risk of secondary failure of repair. Further prospective research with increased sample size and longer follow‐up periods is required to assess the validity of the findings. [ABSTRACT FROM AUTHOR]

This article, titled "Ileoanal pouch excision: How multiple technical failures can lead to pouch dysfunction—a video vignette," discusses the case of a 56-year-old woman who was referred to a pouch center after experiencing complications from a previous surgery. The patient had undergone an open restorative proctocolectomy with loop ileostomy, which was complicated by an anastomotic leak, pelvic sepsis, and a pouch vaginal fistula. After a thorough evaluation and multidisciplinary team discussion, the patient underwent a pouch excision and redo pouch procedure. During surgery, it was discovered that the chronic ischaemia and severe atrophy of the small bowel were caused by an unexpected twist in the ileostomy mesentery. Another technical issue was the improper positioning of the loop ileostomy relative to the ileoanal pouch, which prevented the creation of a new pouch. The article emphasizes the importance of patient centralization in inflammatory bowel disease to ensure better outcomes and highlights the potential consequences of multiple technical failures in nonreferral IBD centers. The authors also mention that they obtained consent from the patient for the publication of footage and videos, and ethical committee approval was not required. [Extracted from the article]

Aim: Conventional surgical management of colovesical and colovaginal fistulas can be morbid and is contraindicated in many patients. Our aim in this work is to evaluate our experience in the management of colovesical and colovaginal fistulas with endoscopic over‐the‐scope (OTS) clips. Method: A retrospective review of all patients who underwent attempted endoscopic OTS clip management of colovesical and colovaginal fistulas between 2013 and 2020 was performed. Preoperative risk factors, operative details and postoperative outcomes are reported. Results: Ten patients were identified. Fistula types were: colovesical (five), rectovesical (two), colovaginal (two) and rectovaginal (one). The aetiology of the fistula was diverticular disease in seven (70%) cases and surgical complication of pelvic surgery in three (30%). The mean defect age was 157 ± 98 days, the mean defect diameter was 4.5 mm (range 2–10 mm) and the mean fistula length was 15 mm (range 2–25 mm). In nine (90%) cases, fistula identification and cannulation were performed through the nonenteric lumen of the fistula. Initial management with an OTS clip was technically successful in eight (80%) patients. Of the eight patients who underwent OTS clip placement, long‐term success (mean follow‐up 218 days, range 25–673 days) was achieved after initial intervention in four (50%) patients. One patient underwent serial OTS clip procedures and achieved long‐term success after four interventions; three patients have not undergone a repeat procedure after initial failure. Conclusion: Endoscopic management of colovesical and colovaginal fistulas with OTS clips offers a promising therapeutic option for patients with contraindications to conventional surgical management. Immediate technical success and long‐term success rates are similar to other gastrointestinal tract applications of OTS clips. [ABSTRACT FROM AUTHOR]

Aim: Ileoanal pouch–vaginal fistula (PVF) is a relatively common complication of restorative proctocolectomy with ileal pouch–anal anastomosis. There are several operative approaches in the management of PVF. There is currently no consensus as to which approach is the most effective or which should be attempted first. Method: A systematic review was undertaken following a publicly available protocol registered with PROSPERO (CRD42019133750) in accordance with PRISMA guidelines. Online searches of databases MEDLINE and Embase, Cochrane Library, ClinicalTrials.gov, EU Clinical Trials and ISRCTN registry were performed. Results: Twenty‐seven articles met the criteria for inclusion in the study: 13 retrospective cohort studies, two prospective cohort studies, eight case series, three case reports and a case–control study. A narrative synthesis was performed due to heterogeneity between included articles. Our study included 577 PVFs, and the incidence rate was 2.1%–17.1%. Both local and abdominal approaches were used in the management of PVF. The overall success of local and abdominal procedures was 44.9% and 60.2% respectively. ROBINS‐I assessment revealed a critical risk of bias. GRADE assessment indicated a very low certainty in effect size and evidence quality. Conclusion: Local interventions and abdominal approaches have a high failure rate. The results of this review will aid the counselling of patients with this condition. Furthermore, we provide an algorithm for discussion on the management of PVF based on experience at our local centre. The studies available on the management of PVF are low quality; a large prospective registry and Delphi consensus are required to further this area of research. [ABSTRACT FROM AUTHOR]

Aim: Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gastrointestinal continuity following proctocolectomy. It is often associated with improved quality of life and high patient satisfaction; however, the development of a pouch anal fistula can cause significant morbidity. Pouch fistulas are notoriously difficult to treat and there is great heterogeneity in the management reported of these fistulas. A lack of classification, and the assumption that fistulas originating from completely different aetiologies will behave and respond similarly to a particular treatment strategy, precludes meaningful comparison of management outcomes. We aim to introduce consistency in the reporting of pouch fistulas using a novel classification system. Methods: A consensus process involving clinicians experienced in the management of pouch fistulas from two high volume tertiary centres was performed. Results: We propose that pouch anal fistulas should be classified into four distinct groups according to their aetiology: group 1, anastomotic related; group 2, inflammatory bowel disease related, with sub‐classifications Crohn's (type A) and non‐Crohn's (type B) in origin; group 3, cryptoglandular related; and group 4, malignancy related. Conclusion: Classification of pouch fistulas according to their aetiology will provide consistency in the literature and improve the quality of prospective evidence for the management of pouch fistulas. [ABSTRACT FROM AUTHOR]

Aim: To compare the functional results and quality of life after delayed colo‐anal anastomosis (DCAA) or immediate colo‐anal anastomosis (ICAA) following redo rectal surgery. Method: Twenty‐six patients with DCAA between 2014 and 2018 were studied retrospectively (group A). Two control groups were used: 26 ICAA after redo surgery (group B) and 52 colo‐anal anastomosis (CAA) after anterior resection (group C). Control groups were matched for age, sex, pelvic radiotherapy and time to surgery. Low Anterior Resection Syndrome (LARS) and Gastrointestinal Quality of Life Index (GIQLI) scores were used to assess function and quality of life. Results: The indications for surgery were comparable for groups A and B: anastomotic failure with chronic sepsis (38% vs 50%, P = 0.40), vaginal fistula (42% vs 42%, P = 1) and urinary fistula (20% vs 8%, P = 0.22) as well as the number of previous abdominal operations (1.3 ± 0.9 vs 1.1 ± 0.6, P = 0.19). The median LARS score in the first 2 years was 30 [interquartile range (IQR) 14–41] for group A, 23 (IQR 0–41) for group B and 22 (IQR 11–37) for group C. After 2 years, the median LARS score improved in each group [A, 21 (IQR 11–35); B, 18 (IQR 5–26); C, 13 (IQR 9–20)], but was still high in group A. There was a tendency toward more major LARS in group A than in group B (46% vs 27%; P = 0.149). There was no difference in the mean GIQLI score between groups A and B (120 ± 16 vs 117 ± 19; P = 0.53) at the end of the follow‐up period. Time after stoma closure (< 2 years) and previous radiotherapy were risk factors for major LARS in all populations. Conclusion: ICAA should be the procedure of choice where possible in redo surgery as it has better functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: Pouch–vaginal fistula (PVF) is an uncommon but serious complication of ileo‐anal pouch reconstruction. This study aimed to review the recent management of PVF, in particular the role of anti‐tumour necrosis factor (anti‐TNF) drugs. Method: All patients presenting for management of PVF to our surgical service between 2007 and 2016 were studied. The median duration of follow‐up from diagnosis of PVF was 6 years. Details of the original pouch surgery, timing of presentation of PVF, management and final outcome were recorded. Primary outcome was gastrointestinal (GI) continuity (as defined by the presence or absence of a stoma). Results: A total of 23 patients were identified (median age 45 years) of whom nine had pelvic sepsis at the time of original pouch surgery. Management included local surgical repair, defunctioning ileostomy, pouch excision and anti‐TNF therapy. GI continuity was achieved in 12 patients (52%). Healing of the PVF was achieved in 12 patients (52%). Pelvic sepsis was significantly associated with the need for a long‐term ileostomy (P = 0.009). Biological therapy was used in 12 patients, of whom seven maintained GI continuity. Patients with late presentation PVF (60 months or longer postsurgery) and those with clinical features of Crohn's disease appeared to benefit from anti‐TNF treatment. Conclusion: PVF remains a challenging problem with overall healing rates and GI continuity rates of just over 50%. Anti‐TNF therapy may have a role in patients with late presentation PVF and those with features suggestive of Crohn's disease. [ABSTRACT FROM AUTHOR]

I Dear Sir i , Here, we present the Martius flap technique for rectovaginal fistula after obstetric injury. Martius flap for rectovaginal fistula after obstetric injury - a video vignette The Martius flap procedure used to repair the fistula is shown in Video S1. [Extracted from the article]

Aim: Pouch-vaginal fistula is an uncommon but unpleasant complication. The chance of successful repair with various surgical procedures is around 50% and the early promise of collagen button plugs was not followed by good long-term results. We report a series of patients who underwent transvaginal repair of pouch- vaginal fistula after failed collagen plugs accompanied by a video to show the operative technique. Method Patients were identified from a prospectively maintained database. Patient demographics, operation notes, complications and ultimate outcome were recorded. Results Eleven patients, each of whom had previously undergone an attempt to close the fistula with a collagen button plug, underwent transvaginal repair. Nine (81%) were successful at a median follow-up of 14 (6-56) months. The remaining two patients reported symptomatic improvement. Conclusion Pouch-vaginal fistula can be successfully closed by the transvaginal technique after a failed button plug procedure. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the impact of complications after surgery for colorectal cancer on quality of life and surgeon-patient relationship, transvaginal repair of recurrent pouch-vaginal fistula, and patients with ulcerative colitis.

The article discusses the case study of a 19-year woman diagnosed with post-coltal rectovaginal fistula and also reflects on the treatment technique.

I Dear Sir i , The rate of postoperative rectovaginal fistula at the anastomotic line of rectal surgery has been reported in approximately 10% of women who undergo low anterior resection [1,2]. Rectovaginal fistulas after rectal cancer surgery: incidence and operative repair by gluteal-fold flap repair. Combined laparoscopic and transanal minimally invasive repair for postoperative rectovaginal fistula - a video vignette. [Extracted from the article]

The article presents a study related to obstetric rectovaginal fistulas. It mentions that the diagnosis are as follows including 13 missed fourth degree tears, five inadequate repairs of fourth degree tears, two repairs broke down from sepsis and three suture penetration of the anorectum during repairs. The study concludes that if a fistula develops early after vaginal delivery, a defunctioning stoma provides an opportunity for spontaneous healing without faecal incontinence.

The article presents a case study of a 66-year old diabetic woman who was taken to the John Goligher Department of Colorectal Surgery in Leeds, England with three-month history of faecal incontinence and passage of faeces per vaginam. She developed diarrhoea which had been managed with an apposite faecal management system during admission to the intensive care unit of another hospital. The article discusses the association of symptoms of vaginal discharge with faecal incontinence.