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Techniques in Coloproctology

, Volume 18, Issue 9, pp 817–823 | Cite as

Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh

  • K. W. A. GöttgensEmail author
  • J. Heemskerk
  • W. van Gemert
  • R. Smeets
  • L. P. S. Stassen
  • G. Beets
  • C. G. M. I. Baeten
  • S. O. Breukink
Original Article

Abstract

Background

A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures.

Methods

This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn’s disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year.

Results

Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30–0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement.

Conclusions

Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.

Keywords

Rectovaginal fistulas Surgical treatment Biomesh Minimal invasive Recurrence 

Notes

Conflict of interest

None.

Supplementary material

Supplementary material 1 (MPG 31,990 kb)

Supplementary material 2 (MPG 32,032 kb)

Supplementary material 3 (MPG 29,924 kb)

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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • K. W. A. Göttgens
    • 1
    • 4
    Email author
  • J. Heemskerk
    • 2
  • W. van Gemert
    • 3
  • R. Smeets
    • 1
  • L. P. S. Stassen
    • 1
  • G. Beets
    • 1
  • C. G. M. I. Baeten
    • 1
  • S. O. Breukink
    • 1
  1. 1.Department of Surgery and Colorectal SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Department of Surgery and Colorectal SurgeryLaurentius HospitalRoermondThe Netherlands
  3. 3.Department of Surgery and Colorectal SurgeryAtrium Medical Center ParkstadHeerlenThe Netherlands
  4. 4.Academical Hospital MaastrichtMaastrichtThe Netherlands

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