title: Surgical repair of rectovaginal fistulas in patients with Crohn's disease.
abstract: OBJECTIVE
  To report surgical outcomes of patients who underwent rectovaginal fistula (RVF) repair with a history of Crohn's disease utilizing several reconstructive techniques.
  
  
  METHODS
  Retrospective case series of women (n=6) with Crohn's disease surgically treated with either vaginal or rectal advancement flaps. Demographic information and data specific to Crohn's disease at the time of surgery were collected. In addition, operative reports and postoperative follow-up visits were reviewed.
  
  
  RESULTS
  During the study period, six women with the diagnosis of Crohn's disease and RVF underwent surgical management. Five patients had a vaginal advancement flap (VAF) by Female Pelvic Medicine and Reconstructive Surgery and one patient was treated by the rectal advancement flap by Colorectal Surgery. The failure rate in our study population was 33% (2/6). Of note, two of the patients who had a successful VAF had a previous failure after RAF. In addition, four patients who had a repair via the transvaginal approach had a concomitant pedicled flap procedure (i.e. Martius or gracilis flap). The average follow-up for all our patients was 5 months (+/- 6.5 months). No patients failed if they received a VAF with a concomitant flap procedure.
  
  
  CONCLUSIONS
  This case series illustrates several techniques utilized for the repair of RVF in patients with Crohn's disease. The use of a bulbocavernosus flap during the primary repair of RVF in this patient population may be considered to bolster the rectovaginal septum.
authors.affiliation: Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Georgetown University School of Medicine, 106 Irving Street, NW Suite 405 South, Washington, DC 20010, United States. Electronic address: patrick.a.nosti@medstar.net.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Nosti
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Stahl
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Sokol
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery
keywords: Crohn's disease; Martius flap; Rectovaginal fistula; Vaginal advancement flap