Ann Surg Treat Res.  2019 Sep;97(3):149-156. 10.4174/astr.2019.97.3.149.

Outcomes of surgical treatments for rectovaginal fistula and prognostic factors for successful closure: a single-center tertiary hospital experiences

Affiliations
  • 1Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kjparkmd@plaza.snu.ac.kr
  • 2Division of Colorectal Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 3Division of Colorectal Surgery, Department of Surgery, Myongji Hospital, Goyang, Korea.
  • 4Division of Colorectal Surgery, Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.
  • 5Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.

Abstract

PURPOSE
Rectovaginal fistula can result from various causes and diverse surgical procedures have developed as a result. We investigated the outcomes of surgical treatments for rectovaginal fistula according to causes and procedures.
METHODS
Between 1998 and 2016, 92 patients underwent 128 operations for rectovaginal fistula. Prospectively collected data were recorded, and a retrospective review was conducted.
RESULTS
The median age was 49 years, and low fistula occurred in 58 patients (63.0%). The most common cause was radiation therapy, followed by pelvic operation, birth injury, perineal operation, cancer invasion, and trauma. The most common procedure during the first operation was diverting ostomy alone, followed by transanal rectal advancement flap, sphincteroplasty with perineoplasty, bowel resection, fistulectomy with seton placement, and Martius flap. Thirty-one patients (33.7%) experienced successful closure after the first operation. Repeated operations were performed in 16 patients (17.4%), including gracilis muscle transpositions, stem cell injections, and Martius flaps. The overall success rate was 42.4% (n = 39). Radiation therapy and pelvic operation as cause of fistula were significantly poor prognostic factors (P = 0.010, P = 0.045) and Crohn disease had a tendency for poor prognostic factors (P = 0.058).
CONCLUSION
Radiation therapy and pelvic operation for cancer were more common causes than birth injury, and these causes of rectovaginal fistula were the most important prognostic factors. An individualized approach and repeated surgeries with complex or newly developed procedures, even among high-risk causes of fistula, may be necessary to achieve successful closure.

Keyword

Fistula; Rectum; Surgery; Vagina

MeSH Terms

Birth Injuries
Crohn Disease
Fistula
Humans
Ostomy
Prospective Studies
Rectovaginal Fistula*
Rectum
Retrospective Studies
Stem Cells
Tertiary Care Centers*
Vagina
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