Abstract
Transvaginal (TV) repair, featuring its feasibility, effectiveness, safety, and technically less demandingness, is one of the surgical approaches for management of rectovaginal fistula (RVF). However, there are limited numbers of publications available on the transvaginal approach for RVF repair. To this end, the purpose of this study is to evaluate the preliminary outcomes of the transvaginal approach performed by the team, and to further assess its feasibility, safety and effectiveness in the management of RVF. A retrospective analysis was conducted at a single institution. Patients with RVF who had undergone three transvaginal surgical techniques, i.e. transvaginal fistulectomy and stratified suture, transvaginal flip and ligation fistula tract and transvaginal fistula stapled closure were included. Besides, the demographics, operative data, postoperative complications and follow-up outcomes of the patients were collected prospectively. A total of 49 female patients (mean age, 35.76 ± 13.97 years) underwent transvaginal approach, 42 of which were followed up with a median follow-up of 26 months (range 3–82 months), and 29 had closure of the fistula (successful closure rate of 59.1%). The successful closure rates were only significantly different between previous repair times (p = 0.031), and several minor complications including postoperative pain (n = 3), constipation (n = 1), and lower urinary tract infection (n = 1) were observed. Symptomatic improvement was reported in all patients with failed closure. Transvaginal approach for RVF repair is effective, safe, and feasible, and is therefore considered an alternative to transrectal advancement flap for low and mid-level traumatic RVF with normal sphincter function. With the advantage of better surgical access, transvaginal approach is recognized as the initial choice for the surgical repair of RVF.
Similar content being viewed by others
References
Ommer A, Herold A, Berg E, Fürst A, Schiedeck T, Sailer M (2012) German S3-guideline: rectovaginal fistula. Ger Med Sci. https://doi.org/10.3205/000166
Lowry AC (2016) Management of rectovaginal fistula. Semin Colon Rectal Surg 27:64–68. https://doi.org/10.1053/j.scrs.2015.12.010
Oh C, Youn JK, Han J-W, Yang H-B, Kim H-Y, Jung S-E, Park K-W (2020) Experiences of rectovaginal fistula in anorectal malformation. J Pediatr Surg 55:1495–1498. https://doi.org/10.1016/j.jpedsurg.2019.06.021
Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD (2010) Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum 53:1240–1247. https://doi.org/10.1007/DCR.0b013e3181e536cb
Dawes AJ, Jensen CC (2021) Rectovaginal fistulas secondary to obstetrical injury. Clin Colon Rectal Surg 34:28–39. https://doi.org/10.1055/s-0040-1714284
Ryoo S-B, Oh H-K, Ha H-K, Han EC, Kwon Y-H, Song I et al (2019) Outcomes of surgical treatments for rectovaginal fistula and prognostic factors for successful closure: a single-center tertiary hospital experience. Ann Surg Treat Res 97:149–156. https://doi.org/10.4174/astr.2019.97.3.149
Abu Gazala M, Wexner SD (2017) Management of rectovaginal fistulas and patient outcome. Expert Rev Gastroenterol Hepatol 11:461–471. https://doi.org/10.1080/17474124.2017.1296355
Hauch A, Ramamoorthy S, Zelhart M, Dobke M (2020) Refining approaches to surgical repair of rectovaginal fistulas. Ann Plast Surg 84:S250–S256. https://doi.org/10.1097/SAP.0000000000002207
Kniery KR, Johnson EK, Steele SR (2015) Operative considerations for rectovaginal fistulas. World J Gastrointest Surg 7:133–137. https://doi.org/10.4240/wjgs.v7.i8.133
Bhama AR, Schlussel AT (2018) Evaluation and management of rectovaginal fistulas. Dis Colon Rectum 61:21–24. https://doi.org/10.1097/DCR.0000000000001004
Chen W, Chen X, Lin G, Qiu H (2016) Successful repair of recurrent rectovaginal fistula by stratified suture using transanal endoscopic microsurgery: a CARE-compliant case report. Medicine 95:e4600. https://doi.org/10.1097/MD.0000000000004600
Bhome R, Monga A, Nugent KP (2018) A transvaginal approach to rectovaginal fistulae for the colorectal surgeon: technical notes and case series. Tech Coloproctol 22:305–311. https://doi.org/10.1007/s10151-018-1775-4
Lin H-C, Huang L, Chen H-X, Zhou Q, Ren D-L (2019) Stapled transperineal fistula repair of rectovaginal fistula: a preliminary experience. Surg Innov 26:66–71. https://doi.org/10.1177/1553350618799452
Göttgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO (2014) The disappointing quality of published studies on operative techniques for rectovaginal fistulas: a blueprint for a prospective multi-institutional study. Dis Colon Rectum 57:888–898. https://doi.org/10.1097/DCR.0000000000000147
Fu J, Liang Z, Zhu Y, Cui L, Chen W (2019) Surgical repair of rectovaginal fistulas: predictors of fistula closure. Int Urogynecol J 30:1659–1665. https://doi.org/10.1007/s00192-019-04082-w
Lowry AC, Thorson AG, Rothenberger DA, Goldberg SM (1988) Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum 31:676–678. https://doi.org/10.1007/s00192-019-04082-w
Byrnes JN, Schmitt JJ, Faustich BM, Mara KC, Weaver AL, Chua HK, Occhino JA (2017) Outcomes of rectovaginal fistula repair. Female Pelvic Med Reconstr Surg 23:124–130. https://doi.org/10.1097/SPV.0000000000000373
Fu W, Yi S, An M, Tang Y, Tang L, Wang Y et al (2020) Effect of diverting stoma for rectovaginal fistula: a protocol of systematic review and meta-analysis. Medicine 99:e23202. https://doi.org/10.1097/MD.0000000000023202
Ruffolo C, Scarpa M, Bassi N, Angriman I (2010) A systematic review on advancement flaps for rectovaginal fistula in Crohn’s disease: transrectal vs transvaginal approach. Colorectal Dis 12:1183–1191. https://doi.org/10.1111/j.1463-1318.2009.02029.x
Corte H, Maggiori L, Treton X, Lefevre JH, Ferron M, Panis Y (2015) Rectovaginal fistula: what is the optimal strategy?: An analysis of 79 patients undergoing 286 procedures. Ann Surg 262:855–860. https://doi.org/10.1097/SLA.0000000000001461
Studniarek A, Abcarian A, Pan J, Wang H, Gantt G, Abcarian H (2021) What is the best method of rectovaginal fistula repair? A 25-year single-center experience. Tech Coloproctol 25:1037–1044. https://doi.org/10.1007/s10151-021-02475-y
Hotouras A, Ribas Y, Zakeri S, Murphy J, Bhan C, Chan CL (2015) Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review. Colorectal Dis 17(2):104–110. https://doi.org/10.1111/codi.12791
Devesa JM, Devesa M, Velasco GR, Vicente R, García-Moreno F, Rey A et al (2007) Benign rectovaginal fistulas: management and results of a personal series. Tech Coloproctol 11:128–134. https://doi.org/10.1007/s10151-007-0342-1
Acknowledgements
Thanks to Dr Chong Hoong Yin for English language editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No conflicts of interest or financial ties to disclose.
Human participants and Informed consent
Disclosure of Research involving human participants and Informed consent The present study was approved by the Ethics Committee of Guang’anmen Hospital of China Academy of Chinese Medical Sciences and received the informed consent from all the patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zeng, Y., He, Y., Li, G. et al. Transvaginal approach for rectovaginal fistula: experience from a single institution. Updates Surg 74, 1861–1870 (2022). https://doi.org/10.1007/s13304-022-01366-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-022-01366-7