Central Surgical AssociationRepair of recurrent rectovaginal fistulas*
Section snippets
Methods
The charts of all women treated for RRVF between 1991 and 2000 were reviewed. Information regarding the etiology of the fistulas and number and method of prior repairs was collected with a standard data collection form. The outcome of the repair was analyzed according to several factors, including etiology of fistulas, number of prior repairs, time interval between last repair and current repair, patient age, and whether a temporary diverting stoma was used.
Results
Between 1991 and 2000, 35 patients with an average age of 37 ± 9.6 years presented with RRVF. The most common complaints were stool per vagina (44%), vaginal drainage (39%), gas per vagina (33%), and pain (12%). Obstetrical injury was the most common etiology of recurrent fistulas (n = 15, 43%), followed by Crohn's disease (n = 12, 34%), fistula occurring after proctocolectomy with IPAA (ulcerative colitis, n = 3; indeterminate colitis, n = 1; familial adenomatous polyposis, n = 1),
Discussion
Recurrent rectovaginal fistulas are a difficult problem for surgeons. MacRae et al5 reported an overall success rate of 61% per procedure for treatment of RRVF. Lowry et al1 reported a success rate of 88% in patients undergoing a primary repair of a rectovaginal fistula. The success rate after one previous failed attempt was 85%, and if the patients had 2 prior repair attempts, the success rate dropped to 55%.1 Decreased success with subsequent repairs may be attributed to unresolved
Conclusion
Most recurrent rectovaginal fistulas can be successfully repaired, although repeated operations may be necessary. Although patients with Crohn's disease have a poorer healing rate compared with those without Crohn's disease, they still have a 50% chance of ultimately healing their rectovaginal fistula. Delaying repair of a recurrent rectovaginal fistula may improve outcome.
Discussion
Dr Janice F. Rafferty (Cincinnati, Ohio). That was a very good presentation regarding a very frustrating problem. Thank you for sending me the manuscript in a timely fashion and for the opportunity to review it.
It is nice to see that you can give us data supporting what we have felt all along, which is the longer you wait, the greater the chance of repair. We all know that these women call our office the day that they begin passing gas after they are repaired, and counseling patients in time
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Cited by (87)
Management of rectovaginal fistula
2016, Seminars in Colon and Rectal SurgeryInfluence of diversion stoma on surgical outcome and recurrence rates in patients with rectovaginal fistula - A retrospective cohort study
2016, International Journal of SurgeryRe-operative surgery for genitourinary fistulae to the colorectum
2015, Seminars in Colon and Rectal SurgeryCitation Excerpt :The success rate after one previous failed attempt was 85%, and if the patients had two prior repair attempts, the success rate dropped to 55%.42 Decreased success with subsequent repairs may be attributed to unresolved inflammation, tension, hematoma, or underlying Crohn׳s disease.41 While in the distant past treatment of Crohn׳s disease-associated rectovaginal fistula has been mostly surgical, complex new medical therapeutic options have taken over for most patients.
Diagnosis and management of rectal fistulizing Crohn's disease
2023, Chinese Journal of Inflammatory Bowel DiseasesRecto-vaginal fistulas. Recommendations of the Polish Club of Coloproctology Scientific Society
2023, Polski Przeglad Chirurgiczny/ Polish Journal of Surgery
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