GRACILIS FLAP IN THE CORRECTION OF RECTOVAGINAL FISTULA DUE TO CROHN'S DISEASE

Case Presentation A 31-year-old female patient with Crohn's disease affecting the colon and ileum since 2013, associated with 4 complex anal fistulas, one of which was rectovaginal. She underwent treatment with sedeno and anti-TNF Adalimumab starting in June 2017, achieving remission of the intestinal disease and healing of the anal fistulas, but the rectovaginal fistula persisted without inflammatory findings in the anal canal. The patient was treated with a vaginal mucosal flap in December 2018, but the procedure was unsuccessful. An ileostomy was performed in July 2019, followed by a right-sided bulbocavernous interposition repair in September 2019 using the Martius technique, which also failed. A second Martius repair was done on the left side in February 2020, also without success. In February 2022, a rectovaginal fistula correction was performed using the gracilis muscle flap. A video describing the detailed technique was recorded.

Discussion Rectovaginal fistulas cause significant reduction in the quality of life, especially in patients with Crohn's disease, and their management is extremely complex and difficult. Surgical interventions are indicated once the inflammatory activity of the disease is controlled. While there is no clear consensus on the preferred procedure, guidelines recommend starting with flaps followed by techniques that involve healthy tissue interposition, such as the Martius flap and the gracilis muscle flap, which was originally described in 1928. Given that this is a complex and rare surgery, we present a video with detailed technical descriptions.

Conclusion The use of the gracilis muscle flap for rectovaginal fistula repair represents an advanced surgical therapy for patients who have failed simpler flap techniques or bulbocavernous muscle interposition procedures.

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Artikel online veröffentlicht:
25. April 2025