Benign rectovaginal fistulas: Management and results of a personal series

被引：21

作者：

Devesa J.M. ^{[1
]}

Devesa M. ^{[2
]}

Velasco G.R. ^{[1
]}

Vicente R. ^{[2
]}

García-Moreno F. ^{[1
]}

Rey A. ^{[1
]}

López-Hervás P. ^{[1
]}

Die J. ^{[1
]}

Molina J.M. ^{[1
]}

机构：

[1] Coloproctology Unit, Department of General Surgery, University Hospital Ramón Y Cajal, Madrid 28034

[2] Coloproctology Unit, Hospital Rúber Internacional, Madrid

来源：

Techniques in Coloproctology | 2007年 / 11卷 / 2期

关键词：

Advancement flap; Fistula; Fistulectomy; Rectovaginal fistula; Sphincteroplasty;

D O I：

10.1007/s10151-007-0342-1

中图分类号：

学科分类号：

摘要：

Background: Treatment of benign rectovaginal fistula has a high failure rate and entails difficult decisions. The purpose of this retrospective study was to clarify the concepts which may improve its management. Methods: Between 1983 and 2004, 46 consecutive women of median age 41 years were treated by the same surgeon. Etiology of simple fistulas was iatrogenic (n=6), obstetric (n=4) and septic (n=3). Complex fistulas were due to inflammatory bowel diseases (IBD) (n=18, 11 pouchvaginal) or were iatrogenic (n=9), actinic (n=5) or septic (n=1). Surgical techniques included endorectal or vaginal advancement flaps, fistulectomy and sphincteroplasty, vaginal/rectal closure and epiploplasty, restorative proctectomy and restorative proctocolectomy. In 20 patients, a diverting stoma was performed as a single procedure or concomitant to the curative attempt. Results: Overall, 33 of the 39 fistulas (85%) treated for cure healed, including all simple fistulas and 20 complex fistulas (8 iatrogenic, 3 actinic, 2 ulcerative colitis without restorative proctocolectomy; 5 pouch vaginal; 1 septic; 1 Crohn's disease) (p=0.009). The first operation for the fistula was curative in 20 of 39 fistulas, including 10 of 13 simple and 10 of 26 complex fistulas (p=0.023). There was no significant age difference between cured and not-cured patients. Conclusions: Simple versus complex fistulas is the most determinant factor for healing. In IBD fistulas, ulcerative colitis shows better prognosis than Crohn's disease. For complex fistulas, a temporary diverting stoma seems necessary. © 2007 Springer-Verlag.

引用

页码：128 / 134

页数：6

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