title: Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function.
abstract: OBJECTIVE
  Rectovaginal fistula (RVF) repair can be challenging. Additionally, women may experience sexual dysfunction and psychosocial ramifications even after a successful repair. The aim of this study was to investigate variables looking for predictors of healing/failure and examine long-term quality-of-life (QOL) and sexual function in women with low RVF from obstetrical or cryptoglandular etiology
  
  
  METHODS
  From June 1997-2009, 268 women underwent RVF repair. Of those, 100 with obstetric or cryptoglandular etiology agreed to participate in this study. Healing, type of procedure, use of seton or stoma, number of previous procedures, smoking, age, body mass index (BMI), dyspareunia, QOL using SF-12, FIQL, IBS-QOL, and female sexual function index was obtained from our prospective database and telephone contact. Fisher's exact test, chi-square test, and multivariable-logistic-regression model were used to identify the variables associated with healing/failure.
  
  
  RESULTS
  Mean follow-up was 45.8 ± 39.2 months; mean age 42.8 ± 10.5 years; and BMI was 28.8 ± 7.6. Sixty (60%) fistulas were obstetric and 40 (40%) cryptoglandular and 68/100 patients (68%) healed. On multivariate analysis, treatment failure was related to a heavier BMI (p = 0.001) and number of repairs (p = 0.02). Looking at each type of repair, episioproctotomy had significant healing compared to the other choices (but was not significant on multivariate analysis). Forty-seven women were sexually active at follow-up and 12/47 (25.5%) reported dyspareunia. Fecal incontinence was reported preoperatively in 42 women, more often in those with obstetric-related RVF (76% vs. 24% p < 0.05). Healing was not affected by age, smoking, co-morbidities, preoperative seton, or stoma use. Fecal and sexual function and QOL were comparable between women with healed and unhealed RVF.
  
  
  CONCLUSIONS
  Patients with higher BMI and more repairs had a decreased healing rate following RVF repair. Despite surgical outcome, QOL and sexual function were surprisingly similar regardless of fistula healing.
authors.affiliation: Pelvic Floor Unit, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Hull
authors.forename: Emilio
authors.initials: E
authors.lastname: Mignanelli
authors.forename: Jeffery
authors.initials: J
authors.lastname: Hammel
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000150:complications / Q000209:etiology / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D016896:Treatment Outcome