Obstetric Trauma Surgery Art & Science: Kees la Stool Fistula

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Within the kees classification the fistula which I does not involve the anatomic stool con
tinence mechanism a without a rectum stricture and without a circumferential defect is a 
kees Ia fistula   so after healing the continence rate will be (almost) 100%.
They are for (almost) 100% combined with a vesicovaginal fistula; unless the cause is
penetration trauma, infection or a surgical complication which is rare.
 So far, a grand total of 1,417 patients with a kees Ia stool fistula were treated
The mechanism is pressure necrosis of the soft tissues between the fetal head and the
maternal sacrum bone

There is a high tendency to spontaneous healing as demonstrated by the fact that 837 
women healed without any surgical intervention during the first 3-6 months post partum; 
many of them already during the first 2 months.

The reconstructive surgery principles are described in a step-to-step manner; and were
applied as guideline in 570 operations in 501 patients.

Since these are proximal fistulas mostly deep inside the vagina with poor visibility, poor
access and poor instrument handling, the operation procedure is complicated though
the final result may be excellent.

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