Analysis of function and predictors of failure in women undergoing repair of Crohn's related rectovaginal fistula.
OBJECTIVE
Crohn's-related rectovaginal fistulae have significant impact on quality of life including sexual function. The aim of this study was to obtain long-term follow-up of Crohn's related rectovaginal fistulae to assess variables that influence surgical success and determine its effects on quality of life and sexual function.


METHODS
All women with Crohn's-related rectovaginal fistulas who underwent surgical repair from 1997 to 2007 were contacted for long-term follow-up. Variables assessed were age, body mass index, smoking, presence of active Crohn's disease, type of surgical procedure performed, use of perioperative seton or stoma, number of previous procedures, time interval between last repair and current repair, use of immunomodulators, and steroids. SF-12, Fecal Incontinence Quality-of-Life Scale, and Female Sexual Function Index were used to assess quality of life and sexual function. Multivariable logistic regression model was used to identify variables associated with surgical failure.


RESULTS
Sixty-five women were identified at median follow-up of 44.6 months (interquartiles, 13.1-79.1) of which 30 patients (46.2%) were successfully healed. Methods of repair included advancement flap (n = 47), episioproctotomy (n = 8), colo-anal anastomosis (n = 7), and fibrin glue or plug (n = 3). Twenty-eight women (43.1%) were sexually active at follow-up, and of those, nine complained of dyspareunia, all within the unhealed group of patients. On multivariate analysis, only immunomodulators were associated with successful healing (p = 0.009). Smoking and steroids were associated with failure (p = 0.04). Sexual function and quality-of-life scores were comparable between healed and unhealed groups.


CONCLUSIONS
Crohn's-related rectovaginal fistulae are difficult to treat. Healing increased with use of immunomodulators; however, smoking and steroids were predictors of failure. Dyspareunia was higher in unhealed women.
Pelvic Floor Unit, Department of Colorectal Surgery-Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Galal
G
El-Gazzaz
Tracy
T
Hull
Emilio
E
Mignanelli
Jeffery
J
Hammel
Brook
B
Gurland
Massarat
M
Zutshi
D000328:Adult; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D011788:Quality of Life; D020127:Recovery of Function; D012006:Rectovaginal Fistula / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology