Assessment of the efficacy of the rectovaginal button fistula plug for the treatment of ileal pouch-vaginal and rectovaginal fistulas.
BACKGROUND
The treatment of rectovaginal and ileal pouch-vaginal fistulas remains a challenging problem for the colorectal surgeon. The aim of this study was to assess the short-term efficacy of the new Surgisis Biodesign rectovaginal button fistula plug in patients with such fistulas.


METHODS
Between May 2008 and September 2008, patients with confirmed rectovaginal and ileal pouch-vaginal fistulas with backgrounds of inflammatory bowel disease were treated with the button fistula plug. The fistulas were assessed by magnetic resonance imaging and/or examination under anesthesia before the procedure.


RESULTS
Twelve patients with a median age of 36 (range, 29-42) years underwent a total of 20 plug insertions. Five patients had confirmed rectovaginal fistulas and seven patients had ileal pouch-vaginal fistulas. At a median follow-up of 15 (interquartile range, 10-21) weeks, 7 of 12 patients (58%) had been treated successfully. Seven of the 20 plugs that were inserted (35%) were successful. This equates to the successful treatment of three of five (60%) of the rectovaginal fistulas, and four of seven (57%) of the ileal pouch-vaginal fistulas. Of the six patients who initially failed, a repeat procedure was performed of which one was successful. Two patients underwent a third repeat procedure, which was again unsuccessful in both cases. The success rate of these eight repeat plug insertions was therefore 12.5%. All plug failures were the result of dislodgement of the plug. There was no morbidity in our series.


CONCLUSIONS
The new button fistula plug successfully treated 7 of 12 (58%) rectovaginal and ileal pouch-vaginal fistulas.
Gonsalves
Simon
S
The John Goligher Department of Colon and Rectal Surgery, The General Infirmary at Leeds, Leeds, LS1 3EX, United Kingdom.
Sagar
Peter
P
Lengyel
John
J
Morrison
Charles
C
Dunham
Richard
R
D020341:Absorbable Implants; D000328:Adult; D001684:Biological Dressings; D039021:Colonic Pouches / Q000009:adverse effects*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012006:Rectovaginal Fistula / Q000601:surgery*; D013630:Tampons, Surgical; D016896:Treatment Outcome; D014624:Vaginal Fistula / Q000601:surgery*