Recto-Urinary Fistula (RUF) treated by Transanal Endoscopic Microsurgery (TEM) Review of the literature and surgical technique.

Abstract:

AIM:Recto-Urinary Fistula (RUF) is a rare complication of pelvic surgery. Different approaches are reported in literature but a gold standard treatment has not yet been achieved. Transanal Endoscopic Microsurgery (TEM) is a miniinvasive approach with well known advantages as magnification, 3D view and lighting of the operative field. Aim of the present review is to report the current evidence in literature about technique and results of RUF treatment by TEM and to suggest some key points for its correct management. MATERIALS OF STUDY:After a medline in Pubmed and Scopus databases, seven papers were eligible for the present study. Data were reviewed on the basis of the cases reported, patient's characteristics, surgical techniques and results. RESULTS:Eighteen cases have been reported in the literature from 1996 to 2005. The healing success rate was 77.8%. Fecal and urinary diversion were performed before TEM-assisted procedure in the 83% and 94% of cases, respectively. Recurrence was observed in four patients (22%). DISCUSSION:A gold standard treatment of RUF should ensure the complete removal of scar tissue around the fistula, in order to perform a tension free suture on healthy margins with adequate vascularization. Preoperative stoma improves the healing of the fistula, reducing local inflammation and infections. CONCLUSIONS:There is not common view of this topic in literature and clarify which could be the best treatment is a key condition due to high failure rate of the surgical proposed techniques. Recurrences treatment has a lower cure rate if compared to primary lesions, nevertheless more studies are required to confirm this data. KEY WORDS:Recto-Urinary Fistula (RUF), Transanal Endoscopic Microsurgery (TEM), Transanal approach. INTRODUZIONE:Le fistole Retto-Urinarie (RUF) sono una rara complicanza della chirurgia pelvica. In letteratura sono stati descritti differenti approcci chirurgici, ma non è stato ancora stabilito un trattamento definitivo. La Transanal Endoscopic Microsurgery (TEM) è un approccio mini invasivo che permette di operare con una visione magnificata in tre dimensioni. Scopo di questa review è di riportare l’evidenza corrente in letteratura riguardo la tecnica e i risultati ottenuti nel trattamento della RUF con la TEM e di suggerire dei punti chiave per il suo corretto trattamento. MATERIALI E METODI:Dopo una ricerca medline nei database di Pubmed e Scopus, sono stati evidenziati sette lavori: i dati sono stati valutati sulla base dei casi riportati, sulle caratteristiche dei pazienti, sulla tecnica chirurgica utilizzata e sui risultati. RISULTATI:In letteratura tra il 1996 e il 2015 sono stati riportati 18 casi di fistola retto-urinaria trattati mediante approccio TEM. Il tasso di successo è stato del 77,8%. Prima del trattamento nell’83% dei pazienti è stata confezionata una stomia di protezione, mentre il 94% presentava un catetere vescicale a permanenza. In 4 pazienti, già precedentemente trattati chirurgicamente o sottoposti a terapia radiante, è stata documentata l’insorgenza di recidiva. DISCUSSIONE:Il trattamento ideale della RUF dovrebbe garantire la resezione completa del tessuto cicatriziale intorno alla fistola, eseguendo la successiva sutura su margini sani adeguatamente vascolarizzati e senza tensione, su due diversi livelli, sul versante rettale e vescicale. La presenza di una stomia consente di proteggere la fistola in guarigione, riducendo l’infiammazione locale e prevenendo le infezioni. CONCLUSIONI:Su questo argomento non vi è ancora consenso in letteratura. Pertanto, chiarire quale possa essere il miglior trattamento è una condizione fondamentale, considerando l’alto tasso di recidive delle varie tecniche proposte. Il trattamento delle recidive, inoltre, ha un tasso di riuscita inferiore rispetto al trattamento primario, nonostante siano richiesti ancora ulteriori approfondimenti per confermare questi dati.

journal_name

Ann Ital Chir

authors

D'Ambrosio G,Intini G,Balla A,Quaresima S,Picchetto A,Seitaj A,Campo S,De Laurentis F,Paganini AM

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

356-361

eissn

0003-469X

issn

2239-253X

pii

S0003469X16025549

journal_volume

87

pub_type

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