Rectovaginal fistula after rectal radiotherapy

Has anyone else developped a rectovaginal fistula after radiotherapy for rectal cancer (after a transanal resection)? Did you undergo surgery to solve it? What surgery did you have? How do you feel about it?

Hi @verol65, I merged your 2 discussions into one. I'm sorry that treatment to treat rectal cancer has led to the complication of a rectovaginal fistula. You may appreciate the posts from @blinken @bjbrocks @mahoney @catherine1290 and others in this related discussion as you investigate your options:

– Has anyone had personal experience with rectovaginal fistula repair? https://connect.mayoclinic.org/discussion/has-anyone-had-personal-experience-with-recto-vaginal-fistula-repair/

Is your surgeon experienced in Turnbull-Cutait pull-through coloanal anastomosis? Would you require an ileostomy after surgery?

Thank you, Colleen!
I will read the posts you've suggested

My surgeon has trained in the US for the two-satge Turnbull-Cutait pull-through coloanal anastomosis and does practice it on average 5 times annually. From my asking around to other doctors, he's THE colorectal surgeon in Monterrey, NL, where I live.
The plan is to avoid an ileostomy.

The post-operatory period scares me. I've made an appointment with a psychologist specialized in oncology and one specialized in hospital healthcare to decide who I feel better with.

Tomorrow at 10:00 am CST, I will have the first stage of the Turnbull-Cutait pull-through with coloanal anastomosis. It's been an arduous emotional journey. I feel privileged to have so many friends who have been sending me support messages these past two days. I feel their warm embrace.

Thinking of you!

How are you doing, @verol65? Thinking of you.

I had the first of my two surgeries on Jan. 26. Original estimated time: 3 hours, pre-surgery estimated time: 4 hours. Real time: 5 hours. The surgeon says he found me bloated, so first he and his assistant had to get rid of the gas in my guts. The low anterior resection and the vaginal flap, which they ended up doing as 3 layers, went basically as planned. They unfortunately found that the fistula was much closer to the sphincter than expected, giving no margin at all, so they had to be extra careful when cutting. He had planned to use part of my omentum to set a barrier between the vaginal wall and the colon, but since I'm rather thin, it ended up not being possible, so they used a biological mesh. They sent the whole of what they resected to the lab for a biopsy; it's so big, they still don't have the results.

I was set on a clear liquid diet (clear apple juice, chamomille tea, chicken broth, jelly), then told I could also drink Ensure Max. I was very bloated. The pain diminished at first, then grew again, so much so that I had a vagal malaise (fainted) on Jan. 31st, in the presence of the surgeon and two residents. He stopped all food and put me on parenteral nutrition with a modified schedule for a medication helping with bowel movements. Anesthesiologist later said my intestine was paralized.

I got better and stronger with the parenteral nutrition, so on Feb. 2, I had the second surgery for the coloanal anastomosis. Again, due to the lack of margin for the sphincter, they had to use an unusual suture technique. They did it in an hour. They sent the cut part to the lab too.

Noon Feb. 3, I was allowed clear liquids again, still with parenteral nutrition. Noon Feb. 4, I was allowed to start limited solids: nothing that can cause gases, low-residue foods, no dairy products. So for now: fish, chicken, some red meat, eggs, little ham, white bread, white rice, potato, pasta, apple, pear, and carrots on the menu. I've lost almost 5 kilos (11 pounds).

Feb. 7, I was sent home with my abdominal drain still in. The skin of my butt cheeks is extremely irritated from the bowel movements, especially the left side because I have a bulge on the right side of the anus that pushes everything left. I try to keep it aired as much as possible, since the creams for that tend to keep humidity in.

I have to be extremely patient because I have no control of my BM. I can be hours without any, then I can have 10, 15 or more BMs in variable quantity in a row. I still have frequent gases. It's frustrating to have no warning and no control.

Update
Last Monday morning, I had a 3-hour-long period of going to the bathroom with light BMs. Tuesday evening and night were five hours of the same, at the end, the BMs turned to liquid. The skin of my butt cheeks and of the vulva was terribly irritated. I ended up calling my surgeon after midnight. Still I had a few mor trips to the bathroom during the night and early morning.

When I called my surgeon, he suggested going back to the hospital, but I would not have it. So he told me to take a fairly strong analgesic I had at home and see him at 8 in the morning. Since I had barely slept, I got in touch with him at that time and explained I could not make it. He was leaving on holidays, so he set me an appointment with his fellow surgeon who had operated on me together with him. I saw that second surgeon early in the afternoon. He took out my abdominal drain, examined me, noted a very inflammed hemorrhoid, and changed my meds to try to regulate my BMs. He called my problem: Low Anterior Resection Syndrome (LARS).

Since then, I had a soft BM on Friday, then since Saturday, I've had periods of about 6 BMs, well-formed and firm, but small, and because of the hemorrhoid, they hurt. I'm also never sure that another BM is not coming. In a way, I'm better, because the urgency is less as to going to the bathroom, no more ardor of the skin, but pain from the hemorrhoid and not being able to push out the BMs.

I've messaged the second surgeon earlier today to explain what's going on and if there's something I could do to make it easier. He's not answered yet.

I don’t have any advice (lots of empathy), but I was directed to a Facebook group for LARS after my ileostomy was reversed. I don’t know if it will help, but I do know there are a lot of people who can help with questions and advice. Please check it out.
Sending support and strength!
https://www.facebook.com/groups/lwlars/?ref=share&mibextid=S66gvF

Thank you for your support and for the tip!!! @cjay