Radiation therapy has provided a powerful and effective modality for control of pelvic cancer. Complications, especially minor radiation injury, have been reduced by modern supervoltage therapy and with the advent of brachytherapy. However, complications, including rectovaginal fistulas, remain problems of substantial surgical importance. Before surgical repair, an understanding of the anatomy and radiation biology will aid in the approach of surgical management. Devascularization and tissue necrosis predisposes each procedure to a high failure rate. An extensive preoperative evaluation will delineate the appropriate candidate for primary repair because only 40% of patients with radiation-induced fistulas undergo primary closure. After thorough examination with multiple biopsies, and a delineation of the extent of the defect, primary repair of the fistula can be pursued. Multiple techniques are available to recruit healthy tissue and vascularity to a necrotic, devitalized area. Meticulous technique in an area devoid of infection is crucial for success. Despite many techniques available, very few radiation-induced rectovaginal fistulas undergo successful primary repair. A complete discussion of the surgical options and potential complications should always be held with the patient before any surgical intervention.
|Original language||English (US)|
|Number of pages||10|
|Journal||Seminars in Colon and Rectal Surgery|
|State||Published - Apr 6 1999|