Functional outcome and quality of life evaluation of graciloplasty for the treatment of complex recto-vaginal and recto-urethral fistulas

  • Arcangelo PicciarielloEmail author
  • Vincenzo Papagni
  • Michele De Fazio
  • Gennaro Martines
  • Riccardo Memeo
  • Antonio Vitarelli
  • Rigers Dibra
  • Donato F. Altomare
Original Article


Recto-vaginal (RVF) and recto-urethral (RUF) fistulas are infrequent but disabling conditions that severely affect patients’ quality of life. Considering the high recurrence rate after conservative approaches, the best surgical treatment is still challenging. The aim of this study was to evaluate the outcome of graciloplasty to treat patients with complex RVF or RUF, and to investigate its effect on the quality of life. Fourteen patients with RVF and RUF who underwent graciloplasty between 2003 and 2017 were retrospectively enrolled. The main outcome was the healing rate of fistulas. Postoperative patients satisfaction was evaluated administering the Clinical Patient Grading Assessment Scale (CPGAS), SF-36 questionnaires and Changes in Sexual Functioning (CSF) questionnaires. The Wexner score was calculated in case of preoperative faecal incontinence. RVF and RUF were iatrogenic in 11 patients and due to Crohn’s disease in 3 cases. After 1 year of follow-up (IQR 10–14 months), the success rate of the procedure was 78%. Out of three patients with RVF due to Crohn’s disease, two healed after the procedure. Six months after surgery, all eight SF-36 domains significantly improved except for “body pain”; CSF score significantly increased from 35.5 (IQR 31–38.7) to 44 (IQR 37.7–48.5); CPGAS score improved from a median value of 0 (IQR 0–0) to 4 (IQR 3.2–4). The Wexner score was calculated only in 5 patients with preoperative faecal incontinence and it significantly decreased from a median value of 12 (IQR 11–14) to 5 (IQR 4–5). Graciloplasty could be considered as a first option treatment for complex or recurrent RVF and RUF. It shows a good healing rate even in case of unfavourable factors like Crohn’s disease.


Rectovaginal fistula Recto-urethral fistula Graciloplasty Outcome 


Compliance with ethical standards

Conflict of interest

All Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Surgery (SIC) 2020

Authors and Affiliations

  1. 1.Department of Emergency and Organ TransplantationUniversity “Aldo Moro” of BariBariItaly
  2. 2.Inter-Department Research Center for Pelvic Floor Disease (CIRPAP)University “Aldo Moro” of BariBariItaly

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