title: Surgical management of rectovaginal fistula in a tertiary referral centre: many techniques are needed.
abstract: OBJECTIVE
  Surgery is the mainstay of treatment for rectovaginal fistula (RVF). Published success rates vary with initial success being around 50% rising to 80% with repeated surgery. Fistulae in Crohn's disease are more likely to recur.
  
  
  METHODS
  A retrospective study was performed of RVF repair carried out between 2003 and 2008 in a tertiary referral centre. Patients undergoing surgery for an RVF under the senior author during the study period were identified and their clinical notes were reviewed.
  
  
  RESULTS
  Thirty-five patients underwent 50 operations. The median age was 42 years and 83% were tertiary referrals. Two patients were lost to follow-up. Healing occurred in 19 (58%) of 33 patients after a mean of 1.4 operations. The median time to success was 11 (2.5-48) months. The 'curative' group had an overall success of 73% (19 of 26). Seventy-five per cent of non-inflammatory bowel disease patients and 67% of those with Crohn's disease had successful treatment of the RVF. Twenty-four of 35 patients (67%) underwent creation of a stoma. Sixteen of 24 (67%) were deemed fit for restoration of continuity. No demographic or disease related factors were found to influence healing.
  
  
  CONCLUSIONS
  Cure of RVF can be achieved by a range of surgical approaches including abdominal and anal. A variety of different anal techniques are necessary, depending on the integrity of the anal sphincter and the presence or absence of perineal descent/internal intussusception.
authors: Imperial College London and St Mark's Hospital, London, UK.
authors: P J
authors: PJ
authors: Tozer
authors: D
authors: D
authors: Balmforth
authors: B
authors: B
authors: Kayani
authors: G
authors: G
authors: Rahbour
authors: A L
authors: AL
authors: Hart
authors: R K S
authors: RK
authors: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Rectovaginal fistula; defunctioning stoma; surgery