Repair of the radiation‐induced vaginal fistula utilizing the martius technique

Abstract

Abstract The radiation‐induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation‐induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus‐labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation .