Surgical Intervention is Effective for the Treatment of Crohn's-related Rectovaginal Fistulas: Experience From a Tertiary Inflammatory Bowel Disease Practice. (11th October 2022)

• Record Type: Journal Article
• Authors: Otero-Piñeiro, Ana M; Jia, Xue; Pedersen, Karina E; Hull, Tracy; Lipman, Jeremy; Holubar, Stefan; Steele, Scott R; Lightner, Amy L
• Is Part Of: Journal of Crohn's and colitis. Volume 17:Number 3(2023)
• Page Start: 396
• Page End: 403
• Publication Date: 2022-10-11
• Subjects: Rectovaginal fistula -- Crohn's disease -- surgical intervention; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjac151
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aims: Rectovaginal fistula occurs in up to 10–20% of women with Crohn's disease, significantly affecting their quality of life. We sought to determine outcomes of single and repeat operative interventions. Methods: A retrospective review of all adult patients with a Crohn's-related rectovaginal fistula, who underwent an operation between 1995 and 2021, was performed. Data collected included patient demographics, Crohn's-related medical treatment, surgical intervention, postoperative outcomes, and fistula outcomes. Results: A total of 166 patients underwent 360 operations; mean age was 42.8 [+/-13.2] years; 34 [20.7%] patients were current and 58 [35.4%] former smokers. The most commonly performed procedure was: a local approach [ n = 160, 44.5%] using fibrin glue, fistulotomy/fistulectomy, or seton placement; followed by a transvaginal/transanal approach [ n = 113, 31.4%] with an advancement flap repair [including Martius advancement flap] and episoproctotomy; a transabdominal approach [ n = 98, 27.2%] including proctectomy or re-do anastomosis; and finally gracilis muscle interposition [ n = 8, 2.2%]. The median number of operative interventions per patient was 2 [1.0–3.0] procedures. The overall fistula healing rate per patient was 71.7% [ n = 119] at a median follow-up of 5.5 [1.2–9.8] years. Factors that impaired healing included former smoking (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31–0.87, p = 0.014) and seton insertion [OR 0.42, 95% CI 0.21–0.83, p = 0.012]. Conclusion: Over two-thirds of Crohn's-related rectovaginal fistulas can achieve closure with multiple surgical interventions. Smoking and seton usage negatively affect healing rates and should be avoided.