Martius flap / J-pouch vaginal fistula repair / ileal pouch advancement flap Video

Video/Learning Objectives:

1) J-pouch fistula background

a. Risk factors
b. Prevalence
c. Basic anatomy review
2) Review the patient’s clinical presentation and diagnosis
a. Detailed explanation and demonstration of the clinical features and diagnostic
modalities used
i. EUA and US findings
ii. Diverting ileostomy for 1 yr
iii. Nutrition consult
3) Surgical technique
a. Elaborate on the step-by-step procedures involved in repairing rectovaginal
fistulas using the Martius flap and endorectal advancement flap techniques.
b. Highlight the nuances of each technique, including incision placement, tissue
handling, and closure methods
4) Multidisciplinary approach
a. Stress the significance of a multidisciplinary team involving colorectal surgeons,
urogynecologists, and other healthcare professionals in managing complex
rectovaginal fistula cases.
5) Post-operative care and follow up
a. Detail the postoperative care regimen, including wound care, dietary
recommendations, and follow-up protocols
b. Talk about martius flap complication >> readmit for debridement and IV abx, d/c
with PO and wound care >> resolved after 2 months with plan for ileostomy
reversal

Outline of Script:

1) Background
2) Patient information
3) “We referred to her a higher volume center but due to economic constraints the patient
was unable to.”