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Rectovaginal fistula (RVF) occurs in women with Crohn's disease (CD) in up to 10-20%, and it leads to significant morbidity and reduced
quality of life.
The main reason for his illness is that inflammation of the anorectum leads to ulceration and eventually erosion of the vaginal wall
.
Depending on the diameter of the fistula and the location associated with the sphincter complex, RVF symptoms may range from almost asymptomatic to causing flatulence or fecal incontinence, vaginal discharge, constipation, constipation, etc
.
There is currently no consensus among gastroenterologists or surgeons on the best treatment algorithm, and that surgical intervention may only exacerbate these symptoms
.
This review sought to determine the treatment outcomes
of single and repeated surgical interventions.
Researchers retrospectively analyzed Crohn's disease-associated rectovaginal fistula
who underwent surgery between 1995 and 2021.
Data collected included patient demographics, medication related to Crohn's disease, surgical interventions, postoperative outcomes and fistula outcomes
.
The patient's surgical outcomes were then statistically analyzed
.
The results of the study showed that a total of 166 patients underwent 360 surgeries; The median age was 42.
8 years
.
Thirty-four (20.
7%) patients smoked
.
The most commonly performed procedures were local methods (n = 160, 44.
5%): fistula glue, fistulotomy/fistulactomy, or seton placement, followed by transvaginal/transanal approach (n = 113, 31.
4%), including anterior segment flap repair (including Martius advancing the flap) and anterior episineal resection; Transabdominal approach (n = 98, 27.
2%), including orthoresection or heavy surgical anastomosis, and finally glacilis muscle insertion (n = 8, 2.
2%).
The median number of surgical interventions per patient was 2 (1.
0-3.
0) surgeries
.
The total healing rate of fistula was 71.
7% (n = 119), and the median follow-up was 5.
5 years
.
Factors impairing healing included previous smoking (OR 0.
52 95%, CI 0.
31 – 0.
87, p = 0.
014).
This study confirmed that more than two-thirds of Crohn's disease-related rectovaginal fistula can be closed with multiple surgical
interventions.
Smoking can negatively affect healing rates and should
be avoided.
Original source:
Ana M Otero-Piñeir.
et al.
Surgical Intervention is Effective for the Treatment of Crohn's related Rectovaginal Fistulas: Experience From A Tertiary Inflammatory Bowel Disease Practice Get access.
Journal of Crohn's and Colitis.
2022.