Surgical Repair of Rectovaginal Fistula after Low Anterior Resection Using Gracilis Muscular Flap: A Case Report

A 63-year-old woman undergoing low anterior resection (LAR) for rectal carcinoma suffered fecal discharge appeared from the vagina starting on 4 postoperative day (POD). Transvaginal fistulectomy, endoscopic fistula closure, and transverse colostomy were not effective. We took a perineal approach using a gracilis muscular flap. After resection of posterior wall of the vagina including the fistula, the defect on wall of the rectum was closed, and the flap anchored on the anterior wall of the rectum. The postoperative course was functionally and cosmetically uneventful. Half of a year later, the transverse colostomy was closed. She now reports no problems. Results thus verified the functional and cosmetic usefulness of the approach using the gracilis muscular flap in rectovaginal fistula after LAR.