Differentiated surgical treatment of rectovaginal fistulae.
OBJECTIVE
Rectovaginal fistulae (RVF) are a serious and debilitating problem for patients and a challenge for the treating surgeons. We present our experiences in the surgical treatment of these patients.


METHODS
Study population consisted of 22 consecutive patients (range 26-70 years) with RVF treated in our department between 2003 and 2009. 13 RVF were observed after colorectal or gynaecological surgery, 3 occurred after radiotherapy, 2 due to tumour infiltration, 4 because of local inflammation (3x diverticultis, 1x ulcus simplex recti). The RVF was classified in all patients before treatment as either 'low' or 'high'.


RESULTS
Local procedures (transvaginal excision, preanal repair) as initial treatment were performed in 9 patients with low fistula. In 13 cases with high fistula an abdominal approach was performed to close the fistula. A recurrence was observed in 8/22 cases (36%), which were treated by a gracilis flap (n=2), a bulbospongiosus composite (n=1), a second abdominal approach (n=4), and a re-local excision (n=1). Ultimatively, in 19 cases the defect healed but in 3 patients the RVF persisted.


CONCLUSIONS
Most important predictor of healing/failure is etiology followed by localization and recurrence of the RVF. Local (preanal, transvaginal) procedures are suitable for low RVF, whereas abdominal surgery is necessary in high RVF. In recurrent RVF, muscle flaps are promising procedures.
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Feride
F
Kröpil
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Andreas M
AM
Raffel
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Matthias
M
Schauer
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Alexander
A
Rehders
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Claus F
CF
Eisenberger
Department of General Surgery, Heinrich-Heine-University Hospital Düsseldorf, Germany.
Wolfram T
WT
Knoefel
gracilis flap; preanal repair; rectovaginal fistula; recurrence