Geovanna Paola Guachagmira Mantilla

Complex rectovesical and rectourethral fistulas represent uncommon but challenging pathological communications between the gastrointestinal and urinary systems, frequently associated with previous pelvic surgery, radiotherapy, malignancy, trauma, and inflammatory conditions. Their management requires comprehensive anatomical evaluation, individualized surgical planning, and multidisciplinary collaboration to achieve durable closure while preserving urinary and gastrointestinal function. This narrative review aimed to analyze the anatomical, diagnostic, and reconstructive characteristics of complex rectovesical and rectourethral fistulas, emphasizing surgical decision-making, postoperative outcomes, and current limitations in the scientific evidence. A structured thematic synthesis of international biomedical literature was developed, incorporating systematic reviews, observational investigations, multicenter studies, and relevant reconstructive reports, including contributions from Latin America. The analysis addressed etiological mechanisms, anatomical assessment, diagnostic imaging, surgical approaches, vascularized tissue interposition, and functional recovery. The reviewed evidence demonstrated substantial heterogeneity in fistula characteristics, reconstructive techniques, and definitions of surgical success. A previously published systematic review involving 416 patients reported an overall surgical closure rate of 87.5%, although differences in patient selection and operative strategies limited direct comparisons. Transperineal reconstruction and gracilis muscle interposition were frequently described in complex rectourethral defects, while transabdominal, transsphincteric, robotic-assisted, and endoscopic approaches demonstrated specific anatomical applications. Multidisciplinary assessment emerged as an important component of reconstructive planning, particularly in patients with previous irradiation, extensive fibrosis, or recurrent fistulas. Anatomical closure did not consistently correspond to complete functional recovery, emphasizing the importance of evaluating urinary continence, bowel function, complications, recurrence, and quality of life. Current evidence remains limited by heterogeneous study designs and insufficient standardization of postoperative outcomes. Comprehensive anatomical characterization, individualized reconstructive selection, and coordinated multidisciplinary management constitute essential principles for addressing complex urinary–rectal fistulas. Further multicenter investigations are necessary to strengthen comparative evidence and establish standardized clinical and functional outcome measures.

Precision in high-risk surgical fields has evolved into a multidimensional paradigm that integrates technological innovation, advanced surgical techniques, and structured perioperative care. This review analyzes the translational principles shared between general surgery, neurosurgery, and minimally invasive approaches, with the aim of understanding how these elements interact to improve surgical outcomes. A structured integrative review was conducted using high-impact literature published from 2020 onward, focusing on key domains such as artificial intelligence, intraoperative monitoring, advanced visualization, laparoscopic and robotic surgery, and Enhanced Recovery After Surgery (ERAS) protocols. The findings demonstrate that precision in surgery is not determined by a single factor, but by the coordinated interaction of multiple components. Minimally invasive techniques serve as the structural foundation, while visualization technologies and intraoperative monitoring enhance real-time decision-making and safety. Artificial intelligence contributes to the standardization and support of surgical cognition, and perioperative protocols optimize recovery and reduce complications. Together, these elements form an integrated system that extends beyond the operating room and encompasses the entire surgical process. The review also highlights the adaptability of these principles across diverse healthcare settings, including regions such as Mexico, Colombia, and Ecuador, where variability in resources requires context-sensitive implementation. Ultimately, precision surgery is defined as a system-based approach that aligns technique, technology, and perioperative care to achieve optimal patient outcomes. This framework has important implications for clinical practice, surgical education, and future research.