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Maspero, Marianna M.D.; Lavryk, Olga M.D., Ph.D.; Prien, Christopher M.D., M.S.; Bandi, Bethany J. M.P.A.S, P.A.-C.; Holubar, Stefan D. M.D., M.S.; Gunter, Rebecca L. M.D., M.S.; Steele, Scott R. M.D., M.B.A.; Hull, Tracy L. M.D.

Author Information

Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio

Funding/Support: None reported.

Financial Disclosure: None reported.

Presented at the scientific meeting for the American Society of Colon and Rectal Surgeons, Seattle, WA, June 3 to 6, 2023.

Correspondence: Tracy L. Hull, M.D., Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106. E-mail: [email protected]; Twitter: @drtracyhull

Diseases of the Colon & Rectum | DOI: 10.1097/DCR.0000000000003128Free Associated Video Metrics

Management of complex, recurrent rectovaginal fistulas (RVFs) is challenging. We present a case of a recurrent RVF after chemoradiation therapy and ultralow anterior resection for rectal cancer. The RVF was first repaired with primary repair and coloanal anastomosis. The RVF recurred, and definitive repair was achieved with a Turnbull-Cutait pull-through coloanal anastomosis (TCA). A TCA is a 2-stage operation involving extrusion of the distal colon from the anus during the first stage.1,2

The colon is left in place for a week, after which the second stage is performed. The extruded colonic segment is amputated and the coloanal anastomosis is matured. At our center, all patients are diverted either before or during TCA. After 3 to 6 months, the patient undergoes an examination under anesthesia and a gastrografin enema, and, if no leak is present, the patient’s ostomy is closed.

Leaving the extruded colonic segment allows for the healthy bowel and surrounding fat to settle in the anal canal without the tension of the anastomotic sutures, promoting healing. For this reason, TCA can be used in complex clinical contexts, such as pelvic fistulas, unhealing anastomotic leaks, and pelvic sepsis, as a last resort to maintain intestinal continuity before creating a permanent ostomy.3 See Video Vignette.

,,]} 1. Cutait DE. Megacolo Nova técnica de retossigmoidectomia abdômino-perineal sem colostomia. In: 1º Congresso Latino-Americano, 11º Internacional e 10º Brasileiro de Proctologia [Anais] São Paulo. 1960;2:831–846. 2. Turnbull RB Jr. Pull-through resection of the rectum, with delayed anastomosis, for cancer or Hirschsprung’s disease. Surgery. 1966;59:498–502. 3. Lavryk OA, Bandi B, Shawki SF, et al. Turnbull-Cutait abdominoperineal pull-through operation: the Cleveland Clinic experience in the 21st century. Colorectal Dis. 2022;24:1184–1191. Keywords:

Recurrent rectovaginal fistula; Rectovaginal fistula; Turnbull-Cutait pull-through coloanal anastomosis

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