Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life View Full Text


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Article Info

DATE

2022-07-02

AUTHORS

Erik V. Söderqvist, Peter H. Cashin, Wilhelm Graf

ABSTRACT

PurposeTo determine the results after rectovaginal fistula (RVF) repair and find predictors of outcome. Primary objective was fistula healing. Secondary outcomes were morbidity and patient health-related quality of life (HRQoL).MethodAn observational study of 55 women who underwent RVF repair including both local procedures and tissue transposition 2003–2018 was performed. Baseline patient and fistula characteristics were registered, combined with a prospective HRQoL follow-up and a general questionnaire describing fistula symptoms.ResultsHealing rate after index surgery was 25.5% (n = 14) but the final healing rate was 67.3% (n = 37). Comparing the etiologies, traumatic fistulas (iatrogenic and obstetric) had the highest healing rates after index surgery (n = 11, 45.9%) and after repeated operations at final follow-up (n = 22, 91.7%) compared with fistulas of inflammatory fistulas (Crohn’s disease, cryptoglandular infection, and anastomotic leakage) that had inferior healing rates after both index surgery (n = 7, 7.1%) and at final follow-up (n = 13, 46.4%). Fistulas of the category others (radiation damage and unknown etiology) included a small amount of patients with intermediate results at both index surgery (n = 1, 33.3%) and healing rate at last follow-up (n = 2, 66.7%). The differences were statistically significant for both index surgery (p = 0.004) and at final follow-up (p = 0.001). Unhealed patients scored lower than both healed patients and the normal population in 6/8 Rand-36 domains, but the differences were not statistically significant.ConclusionsMost traumatic rectovaginal fistulas closed after repeated surgery whereas inflammatory fistulas had a poor prognosis. Low healing rates after local repairs suggest that tissue transfer might be indicated more early in the treatment process. Unhealed fistulas were associated with reduced quality of life.Trial registration Clinicaltrials.gov No. NCT05006586. More... »

PAGES

1699-1707

References to SciGraph publications

  • 2012-01-26. Lower reproductive tract fistula repairs in inpatient US women, 1979–2006 in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2000-11. Simple rectovaginal fistulas in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2008-08-05. Graciloplasty for rectourethral, rectovaginal and rectovesical fistulas: technique overview, pitfalls and complications in TECHNIQUES IN COLOPROCTOLOGY
  • 2007-12-13. Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2019-08-29. Surgical repair of rectovaginal fistulas: predictors of fistula closure in INTERNATIONAL UROGYNECOLOGY JOURNAL
  • 2018-03-30. A transvaginal approach to rectovaginal fistulae for the colorectal surgeon: technical notes and case series in TECHNIQUES IN COLOPROCTOLOGY
  • 2009-05-29. Innovative technique for the closure of rectovaginal fistula using Surgisis™ mesh in TECHNIQUES IN COLOPROCTOLOGY
  • 2010-03-16. Analysis of Function and Predictors of Failure in Women Undergoing Repair of Crohn’s Related Rectovaginal Fistula in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2018-07-07. Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistula: is Crohn’s disease a risk factor for failure? A prospective cohort study in UPDATES IN SURGERY
  • 2020-01-11. Functional outcome and quality of life evaluation of graciloplasty for the treatment of complex recto-vaginal and recto-urethral fistulas in UPDATES IN SURGERY
  • 2010-07-01. Obstetric and Cryptoglandular Rectovaginal Fistulas: Long-term Surgical Outcome; Quality of Life; and Sexual Function in JOURNAL OF GASTROINTESTINAL SURGERY
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    http://scigraph.springernature.com/pub.10.1007/s00384-022-04206-7

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    http://dx.doi.org/10.1007/s00384-022-04206-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1149182652

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35779081


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