Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network.
Document Type
Article
Publication Title
Female pelvic medicine & reconstructive surgery
Abstract
Objectives: Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States.
Methods: This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected.
Results: Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (< 0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists.
Conclusions: In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (< 0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
First Page
123
Last Page
128
DOI
10.1097/SPV.0000000000000162
Publication Date
5-1-2015
Recommended Citation
Oakley SH, Brown HW, Yurteri-Kaplan L, Greer JA, Richardson ML, Adelowo A, Lindo FM, Greene KA, Fok CS, Book NM, Saiz CM, Plowright LN, Harvie HS, Pauls RN. Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network. Female Pelvic Med Reconstr Surg. 2015 May-Jun;21(3):123-8. doi: 10.1097/SPV.0000000000000162. PMID: 25730438; PMCID: PMC4994526.