Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network.
OBJECTIVE
Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States.


METHODS
This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected.


RESULTS
Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (<0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists.


CONCLUSIONS
In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (<0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; §Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ¶¶Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.
Susan H
SH
Oakley
Heidi W
HW
Brown
Ladin
L
Yurteri-Kaplan
Joy A
JA
Greer
Monica L
ML
Richardson
Amos
A
Adelowo
Fiona M
FM
Lindo
Kristie A
KA
Greene
Cynthia S
CS
Fok
Nicole M
NM
Book
Cristina M
CM
Saiz
Leon N
LN
Plowright
Heidi S
HS
Harvie
Rachel N
RN
Pauls
D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016896:Treatment Outcome