Page 245 - Manual of Equine Field Surgery

Rectovagina Fistula Repair 241
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Sutures are positioned approximately 1 cm apart,

avoiding the vaginal and rectal mucosa. Once the

cranial half of the rectovaginal shelf is recon-

structed, closure of the vaginal mucosa is corn-

pleted, followed by closure of the remaining

caudal half of the rectovaginal shelf. The trans-

verse perinea! skin incision is closed with No. 2-0

nonabsorbable suture using a simple interrupted

pattern. If indicated, Caslick's procedure is per-

formed to appose the vulvar opening.

Klug Technique

Fistulas up to 6 cm have been repaired using this

7
technique. The Klug technique provides good

visualization, a durable and stable closure, and

good first-time healing success rate without dis-

rupting the integrity of the anal sphincter. Repair-

ing a large fistula using this technique should be

attempted with caution. Tissue mobilization is A

difficult in large fistula repairs and may require an -

alternative repair method. Cranially located fistu-

las should not be repaired with this technique ·=::_ )

because of inadequate visualization and limited

working room. B

Beginning at the caudal edge of the fistula, an

incision approximately 1 cm in depth is made Figure 43-12 A, An incision ( dotted lines) approxi-

through the vaginal mucosa and subrnucosa mately 1 cm deep is made through the vaginal mucosa
and submucosa beginning at the caudal edge of the
extending caudally to the dorsal cornmissure of fistula and extended to the dorsal commissure of the

the vulva (Figure 43-12). The vaginal mucosa vulva. Essentially, a second-degree perineal laceration is

caudal to the fistula is dissected approximately 2 created. B, Sagittal cross section indicating the length

cm and ventrally reflected. The cranial and lateral and depth of the incision (dotted line) made through

aspects of the fistula are then horizontally split the dorsal vaginal mucosa and submucosa.

through the line of scar tissue and separated into

rectal and vaginal shelves (Figure 43-13 ). Dissec-

tion of the rectal and vaginal shelves should

extend approximately 2 to 3 cm lateral and cranial

to the fistula. Slight caudal traction is applied to

the cranial vaginal shelf, and an interrupted vest-

over-pants pattern using No. 1 absorbable suture

is used to close the fistula (Figure 43-14). The Conversion to Third-Degree Perineal Laceration

cranial vaginal shelf provides the ventral layer,

while the caudal rectal shelf provides the dorsal When fistulas have large diameters or are located

layer of the repair. A shelf overlap of at least 2 cm very cranial or if minimal perineal tissue is

should be obtained (Figure 43-15). The remain- present, conversion into a third-degree perinea!

ing vaginal submucosa should be apposed with laceration and subsequent repair is often recom-

No. 0 absorbable suture 11siI1g a simple inter- mended.Third-degree perineal laceration conver-

rupted pattern. The reflected vaginal mucosa sion is initiated by incising from the caudal

should be apposed with No. 2-0 absorbable suture margin of the fistula through the perineal tissues,

using a continuous horizontal mattress pattern. anal sphincter, and dorsal vulvar commissure.

The rectal mucosa is allowed to heal by second Repair of third-degree lacerations is discussed in

intention. Chapter 42.