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Outcomes of Rectovaginal Fistula Repair
- Source :
- Female pelvic medicinereconstructive surgery. 23(2)
- Publication Year :
- 2017
-
Abstract
- OBJECTIVES Rectovaginal fistulae (RVF) often represent surgical challenges, and treatment must be individualized. We describe outcomes after primary surgical repair stratified by fistula etiology and surgical approach. METHODS This retrospective cohort study included women who underwent surgical management of RVF at a tertiary care center between July 1, 2001 and December 31, 2013. Cases were stratified according to the following etiology: cancer (RVF-C), inflammatory bowel disease or infectious (RVF-I), and other (RVF-O). Patients with prior surgical treatment of RVF were excluded. Surgical approaches included local (seton, plug), transvaginal or endorectal, abdominal, diversion alone, or definitive (completion proctocolectomy with permanent colostomy or pelvic exenteration). Recurrence-free survival was estimated using the Kaplan-Meier method, and comparisons between subgroups were evaluated based on fitting Cox proportional hazards models. Censoring occurred at last relevant clinical follow-up. Factors contributing to recurrence-free survival were evaluated including age, body mass index, smoking status, fistula etiology, ileostomy, and surgical approach. RESULTS During the study period, 107 women underwent surgical repair of RVF. The most common fistula etiology was RVF-I (54.2%), followed by RVF-O (23.4%), and RVF-C (22.4%). Ninety-four women underwent fistula repair by the local (29.9%), transvaginal/endorectal (25.2%), abdominal approach (19.6%), or diversion alone (13.1%), whereas 13 underwent definitive surgery (12.2%). Recurrence-free survival was significantly different depending on surgical approach (P < 0.001), but not etiology (P = 0.71). Recurrence-free survival (95% confidence interval) at 1 year after surgery was 35.2% (21.8%-56.9%) for the local approach, 55.6% (37.0%-83.3%) for the transvaginal or endorectal approach, 95% (85.9%-100%) for the abdominal approach, and 33.3% (15%-74.2%) for those with diversion only. CONCLUSIONS Recurrence rates after RVF repair are high and did not differ by fistula etiology. Abdominal repair of RVF had significantly fewer recurrences.
- Subjects :
- Adult
medicine.medical_specialty
Urology
Fistula
medicine.medical_treatment
Kaplan-Meier Estimate
Infections
03 medical and health sciences
Ileostomy
0302 clinical medicine
Gynecologic Surgical Procedures
Recurrence
medicine
Humans
Aged
Pelvic Neoplasms
Retrospective Studies
Surgical repair
Aged, 80 and over
Pelvic exenteration
business.industry
Proctocolectomy
Rectovaginal Fistula
Obstetrics and Gynecology
Retrospective cohort study
Middle Aged
medicine.disease
Inflammatory Bowel Diseases
Surgery
Treatment Outcome
Rectovaginal fistula
030220 oncology & carcinogenesis
Etiology
030211 gastroenterology & hepatology
Female
business
Subjects
Details
- ISSN :
- 21544212
- Volume :
- 23
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Female pelvic medicinereconstructive surgery
- Accession number :
- edsair.doi.dedup.....83b8f00d1a1e1ddb65605eecd21df712