What is the best method of rectovaginal fistula repair? A 25-year single-center experience

Studniarek, Adam; Abcarian, Ariane M.; Pan, Jennifer Y.; Wang, H.; Gantt, Gerald; Abcarian, Herand

doi:10.1007/s10151-021-02475-y

Cited by 13 publications

(13 citation statements)

References 17 publications

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“…First, we reported that 18.7% of the overall population of those with ARVF have ARVF due to OASIS. This is similar to that found in the literature, which reports rates of ARVF due to OASIS of between 9% and 34% [6, 8, 9, 14]. The present series has the advantage of exclusively focusing on ARVF and of being the largest series of ARVF due to OASIS.…”

Section: Discussionsupporting

confidence: 90%

“…This is in accordance with the recommendation that such a procedure be performed as a primary intervention [10]. Studniarek et al [9] recommend carrying out the endorectal flap procedure in cases of low-lying, simple ARVF as is generally the case in instances of OASIS. However, they do not differentiate between situations in which the sphincters retain their integrity and those in which they are disrupted.…”

Section: Ta B L E 3 Multivariate Analysis Of the Predictive Factors F...supporting

confidence: 79%

“…As the success of management is determined by numerous variables including the aetiology [11], the literature is difficult to analyse because studies comparing the different repair techniques and the need for diverting stoma generally include cases associated with many different aetiologies [6,8,9,12,13], while the prognosis for obstetric and nonobstetric ARVF differs [14]. Specific assessment of ARVF management following OASIS is necessary in order to provide strong evidence on which to base recommendations regarding the best procedure or the need for a diverting stoma.…”

Section: Introductionmentioning

confidence: 99%

“…Mucosal flap or primary closure and sphincteroplasty are associated with a high success rate [4, 9] and the American Society of Colon and Rectal Surgeons (ASCRS) recommends using endorectal advancement flap with or without sphincteroplasty as a primary intervention. However, this recommendation is based on low‐quality evidence [10].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ano‐rectovaginal fistula after obstetrical anal sphincter injury: Diverting stoma does not improve the surgical results

et al. 2022

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Aim Ano‐rectovaginal fistulas (ARVF) are challenging for the surgeon. Most of the series mix aetiologies, leading to confusion with respect to the conclusion. The aim of this study was to assess the factors associated with the success of ARVF management following obstetrical anal sphincter injury (OASIS). Methods This retrospective multicentric study included all the patients undergoing surgery for ARVF identified by the hospital codes. Patients for whom the aetiology of ARVF was not OASIS were excluded. The major outcome measure was the success of the procedure. Results Sixty patients with treated ARVF due to OASIS were identified. The success of overall management was 91.7%. Female patients underwent a mean of 2.5 (±1.7) procedures. A diverting stoma was formed in 29 patients (48.3%) of which 26 were closed at the end of the management period (89.7%). Of the 148 surgical procedures, only 55 were successful (37.2%). The order of the procedures (OR = 1.38; 95% CI: 0.75–2.51) or the diverting stoma (OR = 1.46; 95% CI: 0.31–6.91) were not significantly associated with the success of the surgery. However, Martius flap (OR = 4.13; 95% CI: 1.1–15.54) and Musset procedures (OR = 5.79; 95% CI: 1.77–18.87) produced better results than the endorectal advancement flap (ERAF). The other procedures did not show a significant correlation with management success. Conclusion A diverting stoma is not mandatory in the management of ARVF due to OASIS to improve the success of the surgical procedure. While the Martius flap procedure offers better results, the ERAF procedure may be preferred as a primary intervention in the absence of sphincter injury as it is less invasive. In cases of residual sphincter injury, the Musset procedure is most likely to be the best option.

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Section: Discussionsupporting

confidence: 90%

Section: Ta B L E 3 Multivariate Analysis Of the Predictive Factors F...supporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ano‐rectovaginal fistula after obstetrical anal sphincter injury: Diverting stoma does not improve the surgical results

et al. 2022

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Rektovaginale Fisteln

Schwandner

2024

Chirurgie

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Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

Schoene

Schatz

Brunner

et al. 2023

Int J Colorectal Dis

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Purpose Complex fistulas often require several attempts at repair and continue to be a challenging task for the surgeon, but above all, a major burden for the affected patient. This study is aimed at evaluating the potential of gracilis muscle transposition (GMT) as a therapeutic option for complex fistulas of diverse etiologies. Methods A retrospective study was conducted over a period of 16 years with a total of 60 patients (mean age 50 years). All were treated for complex fistula with GMT at St. Josef’s Hospital in Regensburg, Germany. Follow-up data were collected and analyzed using a prospective database and telephone interview. Success was defined as the absence of fistula. Results A total of 60 patients (44 women, 16 men; mean age 50 years, range 24–82 years) were reviewed from January 2005 to June 2021. Primary fistula closure after GMT was achieved in 20 patients (33%) and 19 required further interventions for final healing. Overall healing rate was 65%. Fistula type was heterogeneous, with a dominant subgroup of 35 rectovaginal fistulas. Etiologies of the fistulas were irradiation, abscesses, obstetric injury, and iatrogenic/unknown, and 98% of patients had had previous unsuccessful repair attempts (mean 3.6, range 1–15). In 60% of patients with a stoma (all patients had a stoma, 60/60), stoma closure could be performed after successful fistula closure. Mean follow-up after surgery was 35.9 months (range 1–187 months). No severe intraoperative complications occurred. Postoperative complications were observed in 25%: wound healing disorders (n = 6), gracilis necroses (n = 3), incisional hernia (n = 2), scar tissue pain (n = 2), suture granuloma (n = 1), and osteomyelitis (n = 1). In 3 patients, a second gracilis transposition was performed due to fistula recurrence (n = 2) or fecal incontinence (n = 1). Conclusion Based on the authors’ experience, GMT is an effective therapeutic option for the treatment of complex fistulas when other therapeutic attempts have failed and should therefore be considered earlier in the treatment process. It should be seen as the main but not the only step, as additional procedures may be required for complete closure in some cases.

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What is the best method of rectovaginal fistula repair? A 25-year single-center experience

Cited by 13 publications

References 17 publications

Ano‐rectovaginal fistula after obstetrical anal sphincter injury: Diverting stoma does not improve the surgical results

Ano‐rectovaginal fistula after obstetrical anal sphincter injury: Diverting stoma does not improve the surgical results

Rektovaginale Fisteln

Gracilis muscle transposition in complex anorectal fistulas of diverse types and etiologies: long-term results of 60 cases

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