title: Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh.
abstract: BACKGROUND
  A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures.
  
  
  METHODS
  This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn's disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year.
  
  
  RESULTS
  Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30-0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement.
  
  
  CONCLUSIONS
  Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.
authors.affiliation: Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands, k.gottgens@me.com.
authors.forename: K W A
authors.initials: KW
authors.lastname: Göttgens
authors.forename: J
authors.initials: J
authors.lastname: Heemskerk
authors.forename: W
authors.initials: W
authors.lastname: van Gemert
authors.forename: R
authors.initials: R
authors.lastname: Smeets
authors.forename: L P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: G
authors.initials: G
authors.lastname: Beets
authors.forename: C G M I
authors.initials: CG
authors.lastname: Baeten
authors.forename: S O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D001672:Biocompatible Materials; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010865:Pilot Projects; D012006:Rectovaginal Fistula / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen