This topic is about a person who developed a large colo-rectal fistula after receiving pelvic radiation for cervical cancer. To manage this, a colostomy was performed. Now, they are considering a surgical procedure called a gracilis muscle flap surgery to close the fistula, which might allow for a possible reversal of the colostomy. Here are some key points and advice related to their situation:

- The gracilis muscle flap surgery involves using muscle from the inner thigh to cover the fistula. However, the surgeon has mentioned a low success rate of 20-30% and is concerned about the condition of the colon.

- The original surgeon is no longer available, so the person plans to consult with another surgeon from the same hospital team soon.

- They are seeking personal experiences from others who have undergone gracilis muscle flap surgery to determine if it is worth pursuing.

Additional details about their situation include:

- The fistula is described as very large and located very low, almost near the anus.

- Initially, an ileostomy was planned, but a colostomy was performed instead during surgery.

- The damage to the colon and the fistula were caused by radiation injury, not an inflammatory disease.

- Research they have read indicates a success rate of only about 17% for gracilis flaps in cases of radiation-damaged colons.

- They are considering keeping the current colostomy and avoiding further surgery.

Advice and insights offered include:

1. Seek additional opinions from surgeons experienced in gracilis muscle transpositions, as success rates can vary based on the surgeon's expertise.

2. Inquire why an end ileostomy with complete colectomy was not performed, as some people have had their diseased colons removed and report a good quality of life with permanent ileostomies.

3. Discuss all details with the surgical team, including indications, alternative operations, exact odds, and cancer recurrence risks, before making a decision.

4. Consider keeping the existing colostomy if it is functioning well, as living with a permanent stoma can be manageable once accepted.

5. Review recent literature on gracilis muscle flap outcomes, as some studies show lower success rates in radiation-damaged patients.

6. Discuss the oncologic prognosis, as removing the colon and forming a permanent ileostomy might be safer if there is any risk of recurrent pelvic cancer.