NEW TECHNIQUE FOR CLOSURE OF RECTOVAGINAL FISTULA USING COMPOSITE POLYPROPYLENE POLYGALACTINE (VYPRO™) MESH RUNNING HEAD: MESH CLOSURE OF RECTOVAGINAL FISTULA

Background: The use of composite polyglactin polyprolene (Vypro) mesh might carry the hope of strengthen the rectovaginal septum with minimal erosion rate. Purpose: To evaluate repair of traumatic rectovaginal fistula by Vypro mesh regarding erosion rate, recurrence and its effect on sexual function. Methods: The study was conducted on twenty female patients. Pre operative data collected from patients included: patients demographics, and a questionnaire for the presenting symptoms. Vypro mesh was inserted between the rectum and vagina through transperineal incision after excision of the fistula. The Cleveland Global Quality of Life (CGQL) score, and CCF continence score, were recorded. Patients were followed up after two weeks, 3months and one year. Results: Mean operative (OR) time was 41.9 ± 19.1 minutes. No postoperative mortalities. Postoperative complications occurred in 7 patients in the form of: urinary tract infection in 2 patients, upper respiratory tract infection in 1 patient and wound infection in 4 patients, all of them started between the 3rd and 6th day postoperative. After 2 weeks 16 patients (80%) showed improvement of symptoms while 4 patients who got wound infection didn t show symptom improvement. After 3 months 18 patients showed symptom improvement while the other 2 patients remained without improvement. 2 patients had mesh erosion. Conclusions: Excision of rectovaginal fistula with reinforcement of rectovaginal septum using Vypro mesh is safe and reliable. Postoperative erosions and recurrences are possible serious inevitable complications in a considerable % of patients