Outcome of surgery for rectovaginal fistula due to Crohn's disease.
BACKGROUND
This study examined the outcome of surgery for symptomatic Crohn's rectovaginal fistula (RVF) and assessed the effect of therapy with antibody against tumour necrosis factor (TNF) on healing.


METHODS
Fifty-six patients with Crohn's disease underwent surgery for a RVF between January 1993 and December 2006. Outcome analysis was performed in February 2008 in relation to the surgical procedures used and the effect of anti-TNF treatment.


RESULTS
Four patients with a healed fistula still had a stoma at final follow-up for other reasons and were excluded from the analysis. Fistula closure was achieved in 81 per cent of the remaining 52 patients. Primary and secondary surgical success rates were 56 and 57 per cent respectively. The primary healing rate was similar in patients who received anti-TNF treatment before the first operation (12 of 18 patients) and those who did not (19 of 34). In univariable analysis, duration of Crohn's disease (P = 0.037) and previous extended colonic resection (P < 0.001) were significantly related to failure of primary surgery, but only the latter remained significant in multivariable analysis (P < 0.001). Late recurrence developed in four patients.


CONCLUSIONS
Fistula closure was achieved in most patients, but more than one operation was often required.
Ruffolo
C
C
Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Penninckx
F
F
Van Assche
G
G
Vermeire
S
S
Rutgeerts
P
P
Coremans
G
G
D'Hoore
A
A
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab