A new method to repair recto-vaginal fistula: Use of human amniotic membrane in an animal model


Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Recto-vaginal fistula is primarily one of the co-morbidities of vaginal delivery. These patients suffer from persistent malodor vaginal discharge. Various surgical techniques have been employed by surgeons in the course of time. This is the first trial of applying Human Amniotic Membrane (HAM) as a bio-prosthesis in repairing recto-vaginal fistula.
Materials and Methods: In a prospective animal study, 8 mixed-breed female dogs weighing 23-27 kg with the age of 12-18 months were selected. They were randomly divided into two groups for standard recto-vaginal fistula repair and fistula repair with human amniotic membrane. The Kruskal-Wallis and Mann Whitney tests were performed to indicate statistical differences.
Results: After 6 weeks, fistulas were evaluated both grossly and microscopically. In gross examination, there were no difference between the two groups and healing of fistula seemed to have been occurred in all dogs expect for one which had a persistent patent fistulous tract. Microscopic healing was scored according to epithelialization, collagenization inflammation, ulcer and necrosis of samples. Healing score was significantly higher in the HAM group than the standard group (P = 0.029).
Conclusion: Our findings revealed that using HAM as a bio-prosthesis to repair recto-vaginal fistula would result in better surgical and histological outcomes comparing to simple repair.


1. Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum 2008;51:1084-8.  Back to cited text no. 1
2. Rahman MS, Al-Suleiman SA, El-Yahia AR, Rahman J. Surgical treatment of rectovaginal fistula of obstetric origin: A review of 15 years′ experience in a teaching hospital. J Obstet Gynaecol 2003;23:607-10.  Back to cited text no. 2
3. Ahmed S, Genadry R, Stanton C, Lalonde AB. Dead women walking: Neglected millions with obstetric fistula. Int J Gynaecol Obstet 2007;99 Suppl 1:S1-3.  Back to cited text no. 3
4. Mehrabani D, Ashraf MJ, Abbasi HR, Amini M, Tanideh N, Sabet B, et al. Comparison of simple closure and polytetrafluroethylene patch methods for repair of rectovaginal fistula in dog. J Appl Anim Res 2009;35:73-6.  Back to cited text no. 4
5. Li Destri G, Scilletta B, Tomaselli TG, Zarbo G. Rectovaginal fistula: A new approach by stapled transanal rectal resection. J Gastrointest Surg 2008;12:601-3.  Back to cited text no. 5
6. González-Contreras QH, Castañeda-Argáiz R, Rodríguez-Zentner HA, Tapia-Cid de León H, Mejía-Ovalle RR, Espinosa-de Los Monteros A. Transposition of gracilis muscle for treatment of recurrent anal and rectovaginal fistula. Cir Cir 2009;77:319-21;297-9.  Back to cited text no. 6
7. Cui L, Chen D, Chen W, Jiang H. Interposition of vital bulbocavernosus graft in the treatment of both simple and recurrent rectovaginal fistulas. Int J Colorectal Dis 2009;24:1255-9.  Back to cited text no. 7
8. David E. Beck M, Patricia L. Roberts M, Anthony J. Senagore M, Michael J. Stamos M, Wexner SD. The ASCRS textbook of colon and rectal surgery. 2 nd ed. New York: springer; 2011.  Back to cited text no. 8
9. Kesting MR, Wolff KD, Hohlweg-Majert B, Steinstraesser L. The role of allogenic amniotic membrane in burn treatment. J Burn Care Res 2008;29:907-16.  Back to cited text no. 9
10. Arai N, Tsuno H, Okabe M, Yoshida T, Koike C, Noguchi M, et al. Clinical application of a hyperdry amniotic membrane on surgical defects of the oral mucosa. J Oral Maxillofac Surg 2012;70:2221-8.   Back to cited text no. 10
11. Uludag M, Citgez B, Ozkaya O, Yetkin G, Ozcan O, Polat N, et al. Effects of amniotic membrane on the healing of primary colonic anastomoses in the cecal ligation and puncture model of secondary peritonitis in rats. Int J Colorectal Dis 2009;24:559-67.  Back to cited text no. 11
12. Barlas M, Gokcora H, Erekul S, Dindar H, Yucesan S. Human amniotic membrane as an intestinal patch for neomucosal growth in the rabbit model. J Pediatr Surg 1992;27:597-601.  Back to cited text no. 12
13. Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A, et al. Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen 2007;15:80-6.  Back to cited text no. 13
14. Schwandner O, Fuerst A, Kunstreich K, Scherer R. Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 2009;13:135-40.  Back to cited text no. 14
15. Beck DE, Roberts PL, Senagore AJ, Stamos MJ, Wexner SD. The ASCRS textbook of Colon and Rectal surgery Second ed. New York: Spring; 2011.  Back to cited text no. 15
16. Kobayashi N, Kabuyama Y, Sasaki S, Kato K, Homma Y. Suppression of corneal neovascularization by culture supernatant of human amniotic cells. Cornea 2002;21:62-7.  Back to cited text no. 16
17. Mohammadi AA, Seyed Jafari SM, Kiasat M, Tavakkolian AR, Imani MT, Ayaz M, et al. Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods. Burns 2013;39:349-53.  Back to cited text no. 17
18. Schimidt LR, Cardoso EJ, Schimidt RR, Back LA, Schiazawa MB, d′Acampora AJ, et al. The use of amniotic membrane in the repair of duodenal wounds in Wistar rats. Acta Cir Bras 2010;25:18-23.  Back to cited text no. 18
19. Uludag M, Ozdilli K, Citgez B, Yetkin G, Ipcioglu OM, Ozcan O, et al. Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing. Int J Colorectal Dis 2010;25:223-32.  Back to cited text no. 19
20. Yetkin G, Uludag M, Citgez B, Karakoc S, Polat N, Kabukcuoglu F. Prevention of peritoneal adhesions by intraperitoneal administration of vitamin E and human amniotic membrane. Int J Surg 2009;7:561-5.  Back to cited text no. 20
21. Aungst MJ, Bearss JJ, Lewis BS, Fischer JR, Bonhage MR, Wright J, Jr. Interposition grafts for rectovaginal fistula repair in the New Zealand white rabbit. Int Urogynecol J 2010;21:737-42.  Back to cited text no. 21