Success and failure after repair of rectovaginal fistula in Crohn’s disease: analysis of prognostic factors

Abstract

Closure of a RVF in Crohn's disease should not be considered an easy undertaking, especially in patients with several Crohn's sites. In this very heterogeneous group of patients the technique is adapted to the nature and the extent of accompanying anorectal disease. Construction of a temporary stoma is not mandatory and can be limited to complex cases. Healing can be obtained in 75% of all patients, although a late recurrence might occur.

Endorectal Advancement Flap

“…Rectovaginal fi stulas associated with Crohn's disease tend to have higher recurrence rates than those due to other etiologies [ 22 , 72 ]. Among those with Crohn's, the number of sites involved with Crohn's has also been found to be associated with outcome [ 73 ], although another study found no association between Crohn's activity and failure [ 26 ]. Thus, endorectal advancement fl ap can certainly be used in an attempt to heal rectovaginal fi stulas associated with Crohn's disease, but success rates are low.…”

Chirurgische und medikamentöse Therapie Morbus-Crohn-assoziierter Fisteln

“…Penninckx et al [11] konnten drei Risikofaktoren für die Abheilung von M.-Crohn-Fisteln herausarbeiten. Sowohl in der uni-als auch in der multivariaten Analyse wurde die Anzahl der zusätzlichen M.-Crohn-befallenen Darmabschnitte als wichtiger prognostischer Faktor identifiziert.…”

“…Sowohl in der uni-als auch in der multivariaten Analyse wurde die Anzahl der zusätzlichen M.-Crohn-befallenen Darmabschnitte als wichtiger prognostischer Faktor identifiziert. In der univariaten Analyse konnten zudem die Präsenz eines zusätzlichen M. Crohn und die Anzahl vorangegangener Fistelverschlüsse als Risikofaktoren charakterisiert werden [11]. …”

Operative Results and Quality of Life After Gracilis Muscle Transposition for Recurrent Rectovaginal Fistula

“…2 Primary repair of RVF is associated with a wide success rate that ranges from 45% to 70%. 1,[3][4][5] When CD is associated, RVF becomes a challenging complication; a number of surgical procedures tend to be unsuccessful and have a high initial failure rate (50%). Therefore, healing can be obtained only after subsequent attempts in two-thirds of patients, with successful stoma closure in 75%.…”

“…Therefore, healing can be obtained only after subsequent attempts in two-thirds of patients, with successful stoma closure in 75%. [5][6][7] Various surgical options have been suggested for RVF repair. These include (from simple to more complex procedures): direct repair, fistulotomy, fibrin glue instillation, endorectal or vaginal advancement flap, abdominal procedures with colorectal or coloanal anastomosis, and epiplooplasty.…”