Rektovajinal Fistül
Özet
Rektovajinal fistüller (RVF), rektum ile vajina arasında gelişen ve kadınların yaşam kalitesini, cinsel sağlığını ve sosyal konforunu ciddi şekilde bozan anormal bağlantılardır. Bu durum sıklıkla kötü kokulu vajinal akıntı, enfeksiyonlar ve hijyen sorunlarına yol açar. Etiyolojisinde en büyük payı doğum sırasında oluşan yırtılmalar ve epizyotomiler alırken, Crohn hastalığı ikinci en sık neden olarak öne çıkar; ayrıca maligniteler, radyoterapi ve cerrahi komplikasyonlar da önemli faktörlerdir. Tanı sürecinde hasta hikayesi ve fizik muayene temel teşkil etmekle birlikte, fistülün anatomisini belirlemek için endoanal ultrasonografi, MRG ve vajinografi gibi görüntüleme yöntemlerinden faydalanılır. Tedavi yaklaşımı fistülün yüksekliğine, boyutuna ve altta yatan nedene göre kişiselleştirilir. Küçük ve semptomsuz fistüllerde medikal izlem tercih edilebilirken, çoğu vakada cerrahi müdahale esastır. Cerrahi seçenekler arasında transanal ilerletme flepleri (ERAF), Martius onarımı, grasilis kası interpozisyonu ve kompleks vakalarda transabdominal yaklaşımlar yer alır. Özellikle Crohn hastalarında cerrahi öncesi inflamasyonun kontrol altına alınması kritiktir. Başarı oranları tekniklere ve vaka özelliklerine göre %40-95 arasında değişse de, altta yatan hastalığa bağlı nüks riski her zaman mevcuttur.
Rectovaginal fistulas (RVF) are abnormal connections between the rectum and the vagina that severely impair women's quality of life, sexual health, and social comfort. This condition frequently leads to foul-smelling vaginal discharge, infections, and hygiene issues. While birth-related lacerations and episiotomies account for the majority of the etiology, Crohn's disease stands out as the second most common cause, with malignancies, radiotherapy, and surgical complications also being significant factors. Although patient history and physical examination form the basis of the diagnosis, imaging methods such as endoanal ultrasonography, MRI, and vaginography are utilized to determine the fistula's anatomy. The treatment approach is personalized according to the height, size, and underlying cause of the fistula. While medical monitoring may be preferred for small and asymptomatic fistulas, surgical intervention is essential in most cases. Surgical options include transanal advancement flaps (ERAF), Martius repair, gracilis muscle interposition, and transabdominal approaches for complex cases. Particularly in Crohn's patients, controlling inflammation before surgery is critical. Although success rates vary between 40-95% depending on the techniques and case characteristics, there is always a risk of recurrence depending on the underlying disease.
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