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Purpose: We reviewed our experience with gracilis transposition for treatment of complex fistulas and reconstruction of perineal defects.
Methods: After IRB approval, we conducted a retrospective review of all gracilis muscle transpositions performed for complex fistulas and perineal defects from 1/2001-9/2011. Patients were divided into three groups: rectovaginal fistulas, rectourethral fistulas and perineal defects.
Results: 97 gracilis transpositions were performed in 86 patients. 43 interpositions were performed in 33 females for rectovaginal fistulas and 5 for pouch-vaginal fistulas; 52% had a mean of 1.5 (1-4) failed repairs prior to gracilis interposition. The overall success rate was 89%; with an 18% post-operative complication rate. 4 patients required a second gracilis interposition. All Crohn’s disease-associated fistulas (7) healed; however 42% required further procedures. 48 interpositions were performed in 42 males for rectourethral fistulas primarily due to prostate cancer treatment (95%); 29% had a mean of 1.2 (1-3) failed repairs prior to gracilis interposition. The overall success rate was 95%; with a 26% post-operative complication rate. 6 patients required a second gracilis interposition. 6 transpositions were performed for reconstruction of perineal defects in 2 females and 4 males; 33% had a mean of 1.5 (1-3) failed repairs prior to gracilis transposition. The overall success rate was 100% with a 33% complication rate.
Conclusion: Gracilis muscle transposition is a versatile and effective technique for treatment of complex fistulas and reconstruction of perineal defects.