Results of combined medical and surgical treatment of recto-vaginal fistula in Crohn's disease.
OBJECTIVE
Surgical repair of recto-vaginal fistula (RVF) in Crohn's disease (CD) has been associated with high rates of failure. The aim of this study was to compare the outcome in patients with CD who underwent RVF surgery with or without infliximab infusion.


METHODS
A retrospective review was carried out of 51 consecutive patients with CD treated for a symptomatic RVF between March 1998 and December 2004.


RESULTS
Fifty-one patients (mean age 39 years) underwent 65 procedures, including seton drainage (n = 35), advancement flap (n = 8), fibrin glue injection (n = 8), transperineal repair (n = 6), collagen plug placement (n = 4) and bulbocavernosus flap (n = 4). All patients were on medical treatment at the time of surgery and 26 patients had received preoperative infliximab treatment (minimum of three infusions, 5 mg/kg). Ten patients underwent preoperative diversion. At a mean follow up of 38.6 months, 27 fistulas (53%) had healed and 24 (47%) had recurred. Fistula healing occurred in 60% of patients treated with preoperative diversion, whereas 51% of nondiverted repairs were successful. Neither active proctitis nor infliximab therapy significantly affected fistula healing. Fourteen (27%) patients eventually required proctectomy.


CONCLUSIONS
RVF in CD is difficult to treat. Failure rates are significant despite repeated surgical interventions and concomitant medical treatment.
Gaertner
W B
WB
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. gaert015@umn.edu
Madoff
R D
RD
Spencer
M P
MP
Mellgren
A
A
Goldberg
S M
SM
Lowry
A C
AC
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003125:Colostomy; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications*; D004322:Drainage; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007081:Ileostomy; D000069285:Infliximab; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D015718:Fibrin Tissue Adhesive; D000069285:Infliximab