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. 2019 Sep;97(3):149-156.
doi: 10.4174/astr.2019.97.3.149. Epub 2019 Aug 29.

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

Seung-Bum Ryoo  1 , Heung-Kwon Oh  1   2 , Heon-Kyun Ha  3 , Eon Chul Han  1   4 , Yoon-Hye Kwon  1 , Inho Song  1 , Sang Hui Moon  1 , Eun Kyung Choe  1   5 , Kyu Joo Park  1
Affiliations

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

Seung-Bum Ryoo et al. Ann Surg Treat Res. 2019 Sep.

Erratum in

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.

Keywords: Fistula; Rectum; Surgery; Vagina.

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Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Recurrent operations for rectovaginal fistula (n = 128). RVF, rectovaginal fistula. a)The first operation in our institute. b)The number of patients and rate of successful closure after surgical procedure.
See this image and copyright information in PMC

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