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Outcome and quality of life following gracilis muscle transposition flap in management of recurrent and complex rectovaginal fistulas

Background Treatment of complex and recurrent rectovaginal fistulas (RVF) is a challenge, with high recurrence rates. Gracilis muscle transposition (GMT) is an option for management of such cases. The aim of this study was to evaluate the outcome of GMT in management of patients with recurrent or complex RVF and the effect of this procedure on the quality of life (QoL) and the sexual function. Patients and methods The current study included 23 female patients presented with recurrent and complex RVF who were eligible to undergo GMT. Early postoperative complications were reported. Follow-up was extended up to 24 months to detect recurrence. QoL and sexual function were evaluated using Colorectal-Anal Impact Questionnaire-7 scale from Pelvic Floor Impact Questionnaire-short form 7 and the Female Sexual Function Index, respectively. Result The mean age of the included patients was 43.6±10.16 years. Early postoperative follow-up reported surgical site infection and functional lower limb problem in 13%, and hematoma, deep vein thrombosis, and hypoesthesia in only 4% of cases for each. Recurrence was reported in 21.5% of cases, with fistula-free time of 7.6±2.3 months. There was a statistically significant difference in Female Sexual Function Index in patients with preoperative sexual problem (P=0.001) and in Colorectal-Anal Impact Questionnaire-7 scale before and after graciloplasty (P=0.0001). Conclusion GMT is assumed to be an optimal option for recurrent and complex RVFs, with minimal postoperative complications and high success rates. Patients who underwent GMT showed significant improvement of the female sexual function and the overall QoL.