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What is the best method of rectovaginal fistula repair? A 25-year single-center experience

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Abstract

Background

The surgical treatment of rectovaginal fistula (RVF) remains challenging and there is a lack of data to demonstrate the best, single procedure. The aim of this study was to assess the results of different surgical operations for rectovaginal fistula.

Methods

Patients with RVF who underwent surgical repair between 1992 and 2017 at a single, tertiary care center were included. Twenty different procedures were performed including: primary closure, closure with sphincter repair, flap repairs, plug/fibrin/mesh repair, examination under anesthesia (EUA) ± seton placement, abdominal resections with and without diversion and ileostomy takedown, gracilis muscle transposition, fistulotomy/ligation of intersphincteric fistula tract. All patients with RVF due to diverticulitis and patients without complete data from paper charting were excluded. Success was defined based on the absence of symptoms related to RVF and absence of diverting stoma at 6 months.

Results

One hundred twenty-four women were analyzed. The median age was 45 (range 18–84) years. Median follow-up time from the last procedure was 6 months (range 0–203 months).

The total number of patients considered successfully treated at the end of their treatment was 91 (91/124, 73.4%). When considering all procedures (n = 255), the success rate for flap procedures was 57.9% (22/38), followed by abdominal resections with and without proximal diversion and ileostomy takedown (16/29, 55.2%) and primary closure with sphincter repair (17/32, 53.1%) while fistula plug, and fibrin glue had among the lowest success rates (4/22, 18.2%). The highest success rate was observed among patients whose RVF etiology was due to malignancy (11/16, 68.8%) followed by unknown (8/14, 57%) and iatrogenic (21/48, 43.8%) causes.

Conclusions

Local procedures such as mucosal flap or primary closure and sphincteroplasty are associated with a high success rate should be considered in patients with low-lying, simple RVF. Abdominal resections with and without proximal diversions and ileostomy takedown have a relatively high success rate in selected patients. The low success rate of fibrin glue and fistula plugs demonstrates their low efficacy in RVF; thus, these procedures should be avoided in the treatment algorithm.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, University of Illinois at Chicago, 840 S. Wood St., Suite 518E CSB (MC 958), Chicago, USA

    A. Studniarek, J. Pan, G. Gantt Jr & H. Abcarian

  2. Cook County Health and Hospitals Systems, Chicago, IL, USA

    A. Abcarian & H. Abcarian

  3. Division of Epidemiology and Biostatistics, and Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL, USA

    H. Wang

Authors
  1. A. Studniarek
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  2. A. Abcarian
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  3. J. Pan
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  4. H. Wang
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  5. G. Gantt Jr
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  6. H. Abcarian
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. A, Dr. G, Dr. S, and Dr. P. The first draft of the manuscript was written by Dr. S and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. Studniarek.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal informed consent is not required.

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Studniarek, A., Abcarian, A., Pan, J. et al. What is the best method of rectovaginal fistula repair? A 25-year single-center experience. Tech Coloproctol 25, 1037–1044 (2021). https://doi.org/10.1007/s10151-021-02475-y

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  • DOI: https://doi.org/10.1007/s10151-021-02475-y

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