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New surgical technique for rectovaginal fistulas in horses
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Postpartal rectovaginal fistulas in horses are sometimes seen and require surgical intervention. This new technique, using a vaginal mucosal pedicle flap, was developed at the University of Leipzig, Germany. It seems a very useful alternative to the established surgical techniques, and one mare foaled subsequently without complications.
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Three mares with RVF were included in this clinical study.
Technique: After debriding the RVF, a dorsally based U-shaped mucosal and submucosal pedicle flap (2-4 mm thick) was dissected from the vaginal wall, rotated approximately 90° angle to close the ventral aspect of the fistula and sutured in position with 10-13 single sutures that did not penetrate the rectal mucosa. This positioned the vaginal mucosa so that it was continuous with the rectal mucosa.
Results: Two RVF healed by 1st intention whereas for the 3rd RVF, 2 additional single sutures were required to repair partial dehiscence after 10 days. At 6 weeks and 6 months all RVF were healed. One mare subsequently foaled without complications.
Thus, tension-free closure of RVF can be achieved by rotating a pedicle flap of vaginal mucosal tissue without undue wound tension, and should be considered as an alternative to conventional appositional techniques.
Source: Schönfelder, Axel M. & Sobiraj, Axel (2004): A Vaginal Mucosal Pedicle Flap Technique for Repair of Rectovaginal Fistula in Mares. In:
Veterinary Surgery 33 (5), 517-520.
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