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

Annals of Surgical Treatment and Research 2019년 97권 3호 p.149 ~ 156
 ( Ryoo Seung-Bum ) - Seoul National University College of Medicine Department of Surgery

 ( Oh Heung-Kwon ) - Myongji Hospital Department of Surgery
 ( Ha Heon-Kyun ) - Seoul National University College of Medicine Department of Surgery
 ( Han Eon-Chul ) - Seoul National University College of Medicine Department of Surgery
 ( Kwon Yoon-Hye ) - Seoul National University College of Medicine Department of Surgery
 ( Song In-Ho ) - Seoul National University College of Medicine Department of Surgery
 ( Moon Sang-Hui ) - Seoul National University College of Medicine Department of Surgery
 ( Choe Eun-Kyung ) - Seoul National University College of Medicine Department of Surgery
 ( Park Kyu-Joo ) - Seoul National University College of Medicine Department of Surgery

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.

키워드

Fistula; Rectum; Surgery; Vagina
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