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Re: r/v fistulaFrom: Hugo D. Ribot Jr. (hribot@mindspring.com)Sun Aug 31 22:32:51 1997
Betsy Hyde wrote:
> Our practice has a multip who developed an RV fistula after her first Betsy: Have had this situation several times before. My $ 0.02: If the fistula is low and close to the external anal sphincter, I have repaired them at the same time( like a third or fourth degree, in layers) and they have all healed very nicely. If the fistula is a significantly greater distance cephalad, I would defer the repair until 6-8 weeks pp. You have to see if the pt has an intact and functioning external anal sphincter coexisting with the fistula you described, or a classic "poorly healed 4th degree" type of picture, where the perineum is either very shortened or absent, with no significant separation between the vaginal and rectal orifices (the so-called "cloaca"). These require more dissection, and I would defer them until the bowel is prepped, you can put the pt on a postop low residue diet, etc. I guess that would be more than my two cents'. Hugo
-- Hugo D. Ribot Jr., M.D., FACOG Cartersville, GA Private Collaborative practice
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