Rectovaginal fistula: Twenty years of rectovaginal repair

Lo, Tsia‐Shu; Huang, Yu-Hsin; Dass, Arjun; Karim, Nazura bt; Uy-Patrimonio, Ma. Clarissa

doi:10.1111/jog.13066

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…In our study, the proportion of RVF etiology was quite different from that of previous reports [5, 7, 15, 16]. Congenital malformation, obstetric injury, and iatrogenic cause represented the majority (85%)of cases in our study, whereas inflammatory bowel disease is the leading cause of RVF in the literature [5, 7].…”

Section: Discussioncontrasting

confidence: 92%

Surgical repair of rectovaginal fistulas: predictors of fistula closure

Liang

Zhu

et al. 2019

Int Urogynecol J

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Introduction and hypothesisWe report the clinical outcome of surgical repair for rectovaginal fistula (RVF) carried out by one operative team. We also investigate the predictive factors for fistula healing.MethodsA retrospective cohort of 63 patients underwent local surgical repair of RVF during January 2008 and December 2017 by one operative group. The clinical features of the patients were reviewed. The association between fistula closure and diverse clinical parameters, including operative method, fistula location, prior repair, and diverting stoma, was analyzed.ResultsSixty-three consecutive patients underwent 80 local surgical repairs by our surgical team. Forty-five patients eventually healed after an average of 1.22 procedures. The overall success rate per procedure was 71.2%, whereas the closure rate of the first operation was 55.5% (n = 35). The etiology of the fistula did not impact on the success rate of surgical repair. The history of prior repair predicted a lower success rate on both overall procedure (RR = 0.59, 95% CI 0.41–0.85, p = 0.008) and the first repair in our institution (RR = 0.50, 95% CI 0.31–0.80, p = 0.003). There was no difference in closure rate between the stoma group and the non-stoma group. Nevertheless, among the 15 patients who underwent more than one operation in our center, a diverting stoma seemed to be necessary (10 patients healed in the stoma group and none of the patients healed in the non-stoma group, p = 0.02).ConclusionsHistory of prior surgical repair is a risk factor for failure. Diverting stoma did not increase the overall closure rate, but it seemed to be necessary for patients in whom the first operation failed.

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Section: Discussioncontrasting

confidence: 92%

Surgical repair of rectovaginal fistulas: predictors of fistula closure

Liang

Zhu

et al. 2019

Int Urogynecol J

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“…A variety of methods and materials have been reported for vaginal repair and RVF treatment [ 12 , 24 – 26 ]. Early intervention including supplementary diverting stoma can improve the success rate of RVF healing [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…To date, there is no standard or widely accepted treatment for RVF [ 10 , 11 ]. Patients who received surgical treatment are generally considered to have a better prognosis compared with those receiving conservative treatment [ 12 ]. However, whether transverse colostomy is superior to ileostomy to repair RVF, whether rectovaginal fistula need to be repaired, and what the optimal time is for stoma closure are still controversial and warrant further investigation.…”

Section: Introductionmentioning

confidence: 99%

Rectovaginal fistula after low anterior resection in Chinese patients with colorectal cancer

Zheng

Guo

et al. 2017

Oncotarget

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Rectovaginal fistula is a postoperative complication of low anterior resection. We investigated the incidence of rectovaginal fistula (RVF) after low anterior resection, its risk factors and its optimal treatment. We analyzed data from 1,493 female patients who underwent low anterior resection for colorectal cancer between January 2006 and March 2016. We calculated the incidence of RVF and performed univariate and multivariate logistic regression analyses to identify risk factors. Twenty-four patients experienced RVF, giving an incidence of 1.61%. Univariate analysis revealed a short distance between the tumor and the anal verge (p < 0.001), longer surgery duration (p = 0.009), unsatisfactory anastomosis (p < 0.001), and greater intraoperative blood loss (p = 0.002) to be risk factors for RVF. Multivariate analysis showed that only distance between the tumor and the anal verge and unsatisfactory anastomosis were risk factors for RVF. Sixteen patients (66.7%) healed within a range of 30-1,225 days (median, 210 days). Twenty-one patients underwent surgery for diverting stoma; of those, 15 of them (71.4%) recovering after ostomy. These results indicate the primary risk factors for RVF are unsatisfactory anastomosis and short distance between the tumor and the anal verge. Most cases of RVF can be healed using a diverting stoma alone, without the need for additional surgery.

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“…30 Lo et al found that 64% of RVF patients treated nonoperatively had improvement in their symptoms at 12 months, but this was less than the 89% who had improvement at 12 months after surgery. 31 In addition to medical management, there are options for limited repair. Fibrin glue injection has definitive closure rates in the 10 to 15% range, and thus is typically reserved for patients who cannot tolerate more invasive procedures.…”

Section: Conservative Managementmentioning

confidence: 99%

Rectovaginal Fistulas Secondary to Obstetrical Injury

Jensen

2020

Clin Colon Rectal Surg

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Rectovaginal fistula (RVF), defined as any abnormal connection between the rectum and the vagina, is a complex and debilitating condition. RVF can occur for a variety of reasons, but frequently develops following obstetric injury. Patients with suspected RVF require thorough evaluation, including history and physical examination, imaging, and objective evaluation of the anal sphincter complex. Prior to attempting repair, sepsis must be controlled and the tract allowed to mature over a period of 3 to 6 months. All repair techniques involve reestablishing a healthy, well-vascularized rectovaginal septum, either through reconstruction with local tissue or tissue transfer via a pedicled flap. The selection of a specific repair technique is determined by the level of the fistula tract and the status of the anal sphincter. Despite best efforts, recurrence is common and should be discussed with patients prior to repair. As the ultimate goal of RVF repair is to minimize symptoms and maximize quality of life, patients should help to direct their own care based on the risks and benefits of available treatment options.

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Rectovaginal fistula: Twenty years of rectovaginal repair

Cited by 18 publications

References 22 publications

Surgical repair of rectovaginal fistulas: predictors of fistula closure

Surgical repair of rectovaginal fistulas: predictors of fistula closure

Rectovaginal fistula after low anterior resection in Chinese patients with colorectal cancer

Rectovaginal Fistulas Secondary to Obstetrical Injury

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