case_images: PMC11193117_01
case_images: Clinical data of a case report of laparoscopic fistula repair for high-level rectovaginal fistula by combined transabdominal-transvaginal approach. (A) Preoperative magnetic resonance imaging (an arrow pointing to the fistula). (B) Postoperative magnetic resonance imaging. (C) Confirm the location of the fistula. (D) Measure the distance between fistula and the vaginal orifice (an arrow pointing to the fistula). (E) Dissect the upper part above the fistula. (F) Transvaginal incision (an arrow pointing to the fistula). (G) Completely dissect the fistula through the transvaginal incision. (H) Utilize a stapler to resect and close the fistula. (I) The stumps of the fistula on both sides after using the stapler. (J) Embed the fistula stump on the rectal side. (K) Tension-free suturing of the vaginal incision. (L) Omental interposition.
case_images: goae068f1.jpg
case_images: PMC11193117_01_goae068f1.jpg
case_images: goae068-F1
case_images: In April 2023, an RVF was diagnosed by magnetic resonance imaging (MRI) (Figure 1A). The fistula was identified on the posterior wall of the vagina at a distance of ~9 cm from the vaginal orifice (Figure 1C and D). The upper segment of the fistula was identified and subsequently dissected (Figure 1E). The vagina was incised transversely ~3 cm below the fistula (Figure 1F). The complete exposure of the fistula was obtained by direct vision following the release of its lower portion (Figure 1G). The fistula was transected through the vaginal incision using an Echelon Flex 60 Endopath stapler (Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA) (Figure 1H and I). The fistula stump and the rectal-side anastomosis were secured with an absorbable 3-0 barbed Stratafix suture (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) (Figure 1J). After the posterior vaginal wall was sutured without tension (Figure 1K), the abdominal operation was reintroduced. China) were utilized to secure the omentum to the rectal side (Figure 1L). The postoperative MRI did not detect the presence of a fistula (Figure 1B).