Surgical management of rectovaginal fistula in a tertiary referral centre: many techniques are needed. (30th July 2013)

• Record Type: Journal Article
• Authors: Tozer, P. J.; Balmforth, D.; Kayani, B.; Rahbour, G.; Hart, A. L.; Phillips, R. K. S.
• Is Part Of: Colorectal disease. Volume 15:Number 7(2013)
• Page Start: 871
• Page End: 877
• Publication Date: 2013-07-30
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12114
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12114-abs-0001"> <title>Abstract</title> <sec id="codi12114-sec-0001" sec-type="section"> <title>Aim</title> <p>Surgery is the mainstay of treatment for rectovaginal fistula (RVF). Published success rates vary with initial success being around 50% rising to 80% with repeated surgery. Fistulae in Crohn's disease are more likely to recur.</p> </sec> <sec id="codi12114-sec-0002" sec-type="section"> <title>Method</title> <p>A retrospective study was performed of RVF repair carried out between 2003 and 2008 in a tertiary referral centre. Patients undergoing surgery for an RVF under the senior author during the study period were identified and their clinical notes were reviewed.</p> </sec> <sec id="codi12114-sec-0003" sec-type="section"> <title>Results</title> <p>Thirty‐five patients underwent 50 operations. The median age was 42 years and 83% were tertiary referrals. Two patients were lost to follow‐up. Healing occurred in 19 (58%) of 33 patients after a mean of 1.4 operations. The median time to success was 11 (2.5–48) months. The 'curative' group had an overall success of 73% (19 of 26). Seventy‐five per cent of non‐inflammatory bowel disease patients and 67% of those with Crohn's disease had successful treatment of the RVF. Twenty‐four of 35 patients (67%) underwent creation of a stoma. Sixteen of 24 (67%) were deemed fit for restoration of continuity. No demographic or disease related factors were found to influence healing.</p> </sec> <sec id="codi12114-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Cure of RVF can be achieved by a range of surgical approaches including abdominal and anal. A variety of different anal techniques are necessary, depending on the integrity of the anal sphincter and the presence or absence of perineal descent/internal intussusception.</p> </sec> </abstract>