MARTIUS FLAP + SPHINCTEROPLASTY FOR RECTOVAGINAL FISTULA TREATMENT – TECHNIQUE DESCRIPTION

Introduction Rectovaginal fistulas are often associated with traumatic injuries after childbirth and are difficult to treat, sometimes requiring more than one approach for complete resolution. There are several available approaches, and tissue interposition techniques (using healthy tissue) seem to yield good results. The Martius flap involves interposition of the bulbocavernosus muscle and has shown to be a minimally invasive option for treating these fistulas.

Objectives Description of the Martius flap technique combined with sphincteroplasty to treat a patient with a rectovaginal fistula and sphincter injury after a long-term vaginal delivery, without previous corrections.

Methods A 37-year-old patient presented with fecal incontinence through the vagina after a vaginal delivery 13 years ago. Colonoscopy and rectal examination identified the fistulous opening to the vagina. Endoanal ultrasound showed a gap in the external sphincter. Sphincteroplasty was chosen with an overlap technique, combined with Martius flap correction. A small incision was made adjacent to the left labium, and the bulbocavernosus muscle was dissected and interposed between the rectum and vagina to prevent fistula recurrence.

Results The patient had an excellent postoperative outcome, with complete resolution of symptoms and early hospital discharge (2nd postoperative day).

Conclusion The Martius flap technique is minimally invasive (requiring small incisions) and has low morbidity, yet is highly effective for treating rectovaginal fistulas. It can be considered a first-line treatment option with good success rates.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025