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Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh

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Abstract

Background

A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures.

Methods

This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn’s disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year.

Results

Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30–0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement.

Conclusions

Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.

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Authors and Affiliations

  1. Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    K. W. A. Göttgens, R. Smeets, L. P. S. Stassen, G. Beets, C. G. M. I. Baeten & S. O. Breukink

  2. Department of Surgery and Colorectal Surgery, Laurentius Hospital, Roermond, The Netherlands

    J. Heemskerk

  3. Department of Surgery and Colorectal Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands

    W. van Gemert

  4. Academical Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    K. W. A. Göttgens

Authors
  1. K. W. A. Göttgens
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  2. J. Heemskerk
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  3. W. van Gemert
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  4. R. Smeets
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  5. L. P. S. Stassen
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  6. G. Beets
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  7. C. G. M. I. Baeten
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  8. S. O. Breukink
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Correspondence to K. W. A. Göttgens.

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Göttgens, K.W.A., Heemskerk, J., van Gemert, W. et al. Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh. Tech Coloproctol 18, 817–823 (2014). https://doi.org/10.1007/s10151-014-1145-9

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  • DOI: https://doi.org/10.1007/s10151-014-1145-9

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