Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter?

Zheng, Yonggui; Zhang, Ning; Lu, Weiqi; Zhang, Liang; Gu, Shouxin; Zhang, Ying; Yi, Xiaofang; Hua, Keqin

doi:10.1177/0300060517728208

Cited by 11 publications

(9 citation statements)

References 47 publications

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“…Among surgical complications, a bowel fistula (anastomotic leakage and rectovaginal fistula) represents the most serious and life-threatening complication occurring from 2.9% to 10.6% of operated patients and leading to longer hospitalization, slower recovery, and eventual second surgery [19].…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Raimondo

Maletta

Borghese

et al. 2021

Journal of Minimally Invasive Gynecology

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To evaluate feasibility of near-infrared (NIR)−indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). Design: This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020. Setting: Tertiary university hospital. Patients: Thirty-two women with RSE meeting eligibility criteria were included for study analysis. Interventions: NIR-ICG evaluation of anastomotic line vascularization after RSE removal. Measurements and Main Results: Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3−5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation. Conclusion: NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.

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Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Raimondo

Maletta

Borghese

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Bowel fistula is the most feared postoperative complication of colorectal surgery for RSE, occurring in up to 10.6% of anastomoses and causing longer hospitalization, slower recovery, and second surgery. 3 After the creation of the anastomosis, adequate bowel perfusion is essential for its healing. 5 Traditionally, surgeons check for vascularization of the bowel after colorectal procedures by evaluating bowel color, vessel pulsatility and, in the case of segmental resection, bleeding from the edges of anastomotic stumps.…”

Section: Main Findings and Interpretationmentioning

confidence: 99%

“…4 Such a complication implies increased hospitalization and recovery time and may require a second surgery. 3,4 As tissue ischemia at the site of the anastomosis is considered one of the main causes for bowel fistula, a more accurate intraoperative assessment of bowel perfusion could in theory reduce the rate of such a complication. 5 Near-infrared fluorescence with indocyanine green (NIR-ICG) enables surgeons to visualize real-time tissue vascularization at the anastomotic site, guiding surgical strategy.…”

Section: Introductionmentioning

confidence: 99%

Indocyanine green fluorescence angiography after full‐thickness bowel resection for rectosigmoid endometriosis: A multicentric experience with quantitative analysis

Raimondo

Maletta

Malzoni³

et al. 2021

Intl J Gynecology & Obste

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Objective: To evaluate effectiveness and reproducibility of qualitative and quantitative near-infrared indocyanine green (NIR-ICG) analyses as a tool for anastomotic perfusion assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). Methods: Symptomatic women with RSE undergoing minimally invasive full-thickness surgical excision of RSE and NIR-ICG evaluation from November 2019 to July 2020 were included. Study outcomes were the accuracy of qualitative and quantitative NIR-ICG analyses in predicting bowel fistula and their reproducibility. NIR-ICG predictive accuracy was assessed by calculating sensitivity, specificity, and area under the curve on receiver operating characteristic curves with 95% confidence intervals (CI). NIR-ICG reproducibility was assessed through Cohen's k coefficient to determine interoperator agreement between two observers.Results: Of 33 patients, 2 (6%) developed bowel fistula. In predicting bowel fistula, qualitative and quantitative NIR-ICG evaluations showed sensitivity of 100% and 100%, specificity of 71% and 93%, and area under the curve of 0.86 (95% CI 0.67-1.00) and 0.96 (95% CI 0-1.00), respectively. Regarding interoperator agreement rate, it was reported as excellent for the qualitative analysis and very good for the quantitative analysis. Conclusion:Qualitative and quantitative NIR-ICG evaluations might be effective and reproducible tools for anastomotic perfusion assessment after discoid or segmental resection for RSE. Quantitative evaluation might be even more effective than qualitative evaluation in predicting bowel fistula.

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“…This is a broad term that covers the majority of fistulas that are known, but not all of them. Fistulae are distinguished from sinuses, infections, and more luminal tracts as well as extraluminal collections based on the broad description [1]. Rectovaginal Fistula (RVF) development is a side effect of an underlying illness, wound, or surgical procedure [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Fistulae are distinguished from sinuses, infections, and more luminal tracts as well as extraluminal collections based on the broad description [1]. Rectovaginal Fistula (RVF) development is a side effect of an underlying illness, wound, or surgical procedure [1,2]. An ongoing connection between the Rectum and vagina might worsen illnesses affecting the pelvic or vaginal organs.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Rectovaginal Fistula: Review Article

Sajjad¹,

Alabdulwahab

Dokhi

et al. 2022

SMHJ

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Background: Rectovaginal Fistula (RVF) development is a side effect of an underlying illness, wound, or surgical procedure. Although there are several surgical approaches for RVF, including advanced flaps, muscle interposition, plugs, and fistula excision, doing so is challenging and painful. The success rate of surgical repair, on the other hand, ranges from 0 to 80%. Objectives:The study aims to summarize current evidences on prevalence, risk factors and management approaches of rectovaginal fistula. Methods:For article selection, the PubMed database and EBSCO Information Services were used. All relevant articles relevant with our topic and other articles were used in the review. Other articles that were not related to this field were excluded. The data was extracted in a specific format that was reviewed by the group members. Conclusion: The first line of defence against perianal sepsis is drainage and possibly seton placement, which may be the only treatment required. Medical treatments are recommended for both local and distant active Crohn's disease (CD). Repairs frequently fail, necessitating reoperative intervention with acceptable outcomes. It is critical to maintain realistic treatment goals and expectations.

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Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter?

Cited by 11 publications

References 47 publications

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Indocyanine green fluorescence angiography after full‐thickness bowel resection for rectosigmoid endometriosis: A multicentric experience with quantitative analysis

Surgical Management of Rectovaginal Fistula: Review Article

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