TEMS: an alternative method for the repair of benign recto-vaginal fistulae

Indications The repair of high recto-vaginal fistula can be challenging since access may be limited via the endo-anal approach yet the alternative trans-abdominal route carries significant morbidity. We report the use of TEMS to repair a recto-vaginal fistula following anterior resection and pelvic radiotherapy. Method The patient was placed prone and a 25cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. Comparison with other techniques TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo-anal or trans-vaginal techniques. The morbidity is lower than the trans-abdominal route. Comments TEMS is a useful technique for the repair of benign recto-vaginal fistula and has distinct advantages over conventional techniques.