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Microbiome diversity predicts surgical success in patients with rectovaginal fistula

A Commentary to this article was published on 27 November 2020


Introduction and hypothesis

Growing literature details the critical importance of the microbiome in the modulation of human health and disease including both the gastrointestinal and genitourinary systems. Rectovaginal fistulae (RVF) are notoriously difficult to manage, many requiring multiple attempts at repair before correction is achieved. RVF involves two distinct microbiome communities whose characteristics and potential interplay have not been previously characterized and may influence surgical success.


In this pilot study, rectal and vaginal samples were collected from 14 patients with RVF. Samples were collected preoperatively, immediately following surgery, 6–8 weeks postoperatively and at the time of any fistula recurrence. Amplification of the 16S rDNA V3-V5 gene region was done to identify microbiota. Data were summarized using both α-diversity to describe species richness and evenness and β-diversity to characterize the shared variation between communities. Differential abundance analysis was performed to identify microbial taxa associated with recurrence.


The rectal and vaginal microbiome in patients undergoing successful fistula repair was different than in those with recurrence (β-diversity, p = 0.005 and 0.018, respectively) and was characterized by higher species diversity (α-diversity, p = 0.07 and p = 0.006, respectively). Thirty-one taxa were enriched in patients undergoing successful repair to include Bacteroidetes, Alistipes and Rikenellaceae as well as Firmicutes, Subdoligranulum, Ruminococcaceae UCG-010 and NK4A214 group.


Microbiome characteristics associated with fistula recurrence have been identified. The association of higher vaginal diversity with a favorable outcome has not been previously described. Expansion of this pilot project is needed to confirm findings. Taxa associated with successful repair could be targeted for subsequent therapeutic intervention.

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Correspondence to Douglas Allan Leach.

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Conflict of interest

This work was supported by a grant from the International Urogynecological Association.

This project was supported by CTSA grant number KL2 TR002379 from the National Center for Advancing Translational Science (NCATS) and was also supported, in part, by a career enhancement award from NIH grant P50 CA136393. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

MWA is a member of the scientific advisory board of LUCA Biologics, Inc., on research related to urinary tract infections, preterm birth and reproductive medicine. These activities do not overlap with the research presented here.

Dr. Leach is a member of the US Armed Forces; the views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of this government agency.

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Leach, D.A., Chen, J., Yang, L. et al. Microbiome diversity predicts surgical success in patients with rectovaginal fistula. Int Urogynecol J 32, 2491–2501 (2021).

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  • Microbiome
  • Rectal
  • Vaginal
  • Rectovaginal fistula
  • Bacterial taxa