title: [Surgical treatment and prognosis of rectovaginal fistulae according to their origin].
abstract: BACKGROUND
  The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis.
  
  
  METHODS
  Between 1 / 2000 and 1 / 2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data.
  
  
  RESULTS
  In a timespan of ten years 36 patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n = 21) and earlier surgical measures (n = 6). Moreover tumour-associated fistulas (n = 5) and fistulas with unknown genesis (n = 4) were seen. As surgical techniques anterior resection (n = 21), transrectal flap plasty (n = 7), subtotal colectomy (n = 3), pelvine exenteration (n = 2) and rectal exstirpation (n = 1) were used. The closure of the vaginal lesion was performed by single suture (n = 25), flap plasty (n = 6), transvaginal omental plasty (n = 2) and posterior vaginal plasty (n = 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12 months (6 - 36). Within this timespan 6 patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n = 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence).
  
  
  CONCLUSIONS
  The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.
authors.affiliation: Universitätsklinikum Schleswig-Holstein Campus Lübeck, Allgemeinchirurgie, Lübeck, Deutschland. e.schloericke@gmx.de
authors.forename: E
authors.initials: E
authors.lastname: Schlöricke
authors.forename: M
authors.initials: M
authors.lastname: Zimmermann
authors.forename: M
authors.initials: M
authors.lastname: Hoffmann
authors.forename: T
authors.initials: T
authors.lastname: Laubert
authors.forename: J
authors.initials: J
authors.lastname: Nolde
authors.forename: P
authors.initials: P
authors.lastname: Hildebrand
authors.forename: H-P
authors.initials: HP
authors.lastname: Bruch
authors.forename: R
authors.initials: R
authors.lastname: Bouchard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery; D003299:Cooperative Behavior; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000150:complications / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009367:Neoplasm Staging; D009852:Omentum / Q000601:surgery; D010385:Pelvic Exenteration; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011351:Proctoscopy; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh; D014621:Vagina / Q000601:surgery; D014625:Vaginal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery