Prise en charge des fistules recto vaginales hautes à l’hôpital de Panzi (RD Congo)

We propose a new minimally invasive treatment consisting of a laparoscopic approach
which minimizes parietal damage and a strategy of dissection wich allows precise
location of the fistula hence reduces blind dissection around the fistula. The pelvis is
often plastered and the only way to initiated the dissection is posteriorly in order to find
the presacral fascia . the previous posterior mobilization of the rectum greatly facilitated
the subsequent anterior dissection and involves the dissection of the vaginal septum
beyond the fistula
if the cleavage plane beyond the fistula addresses a healthy rectum, a suture of vaginal
and rectal defect is performed. if the cleavage plane beyond the fistula involves
significant laceration of the rectum, while leaving at least 2 cm of healthy rectum above
the sphincter, rectal resection and colorectal anastomosis is performed. if the rectal
laceration involves the distal 2 cm but halts short of the sphincter (large fistula) the pullthrough
technique is performed