title: Rectovaginal fistula: Twenty years of rectovaginal repair.
abstract: OBJECTIVE
  To identify the favorable factors in rectovaginal fistula (RVF) management.
  
  
  METHODS
  After Institutional Review Board approval (99-0793B), we retrospectively studied all patients diagnosed, treated and followed up with RVF at Chang Gung Memorial Hospital, Taiwan between January 1990 and December 2009. All female patients with International Classification of Diseases RVF were included. We reviewed demographic data, socioeconomic status, clinical presentation, comorbidities, method of treatment, duration of hospitalization and clinical outcome at 12 months postoperatively.
  
  
  RESULTS
  A total of 397 patients were included in the study. Fifty-six patients (14.1%) had conservative treatment and 341 patients (85.9%) underwent surgical intervention. A total of 125 patients underwent simple repair while 216 patients underwent reconstruction. Three hundred and forty-four patients (86.7%) had improved outcome at 12-month follow up. Age (P = 0.003), education level (P = 0.033), ability to pay insurance (P < 0.001), and choice of treatment (P < 0.0001) were identified as significant favorable factors. An etiological factor associated with favorable outcome was RVF from obstetric complication, while that resulting from malignancy had a less favorable outcome.
  
  
  CONCLUSIONS
  Age, education level and ability to pay insurance significantly affect 12-month outcome of RVF. Surgery is the preferred option, while medical treatment should be used only for small rectovaginal fistulas or for patients not suitable for surgery and anesthesia. More support and assistance should be offered to those patients with unfavorable factors, such as old age, low education level and inability to afford insurance. All RVF secondary to obstetrical injury had a 100% favorable outcome compared with those secondary to surgery or malignancy. Women with suspected RVF should receive prompt and extensive evaluation to ensure immediate effective management and prevention of further serious complications.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan. 2378@cgmh.org.tw.|Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan. 2378@cgmh.org.tw.|Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 2378@cgmh.org.tw.|School of Medicine, Chang Gung University, Taoyuan, Taiwan. 2378@cgmh.org.tw.
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan.
authors.forename: Yu-Hsin
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Urogynaecology Unit, Department of Obstetrics and Gynaecology, Penang Hospital, Penang, Malaysia.
authors.forename: Anil Krishna
authors.initials: AK
authors.lastname: Dass
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Hospital Tuanku Jaafar, Negeri Sembilan, Malaysia.
authors.forename: Nazura
authors.initials: N
authors.lastname: Karim
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Dr Pablo O. Torre Memorial Hospital, Bacolod, Philippines.
authors.forename: Ma Clarissa
authors.initials: MC
authors.lastname: Uy-Patrimonio
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
keywords: demographic factor; prognosis; rectovaginal fistula; surgical procedure; treatment