title: Surgical Treatment of Rectovaginal Fistula in Crohn's Disease: A Tertiary Center Experience.
abstract: BACKGROUND
  Rectovaginal fistula (RVF) is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a woman's quality of life. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics, and its published success rates vary with initial success being around 50% rising to 80% with repeated surgery. Several surgical and sphincter sparing approaches have been described for the management of rectovaginal fistula, aimed to minimize the recurrence and to preserve the continence.
  
  
  METHODS
  A retrospective study was performed for RVF repair between 2008 and 2014 in our tertiary centre at the University Hospital of Tor Vergata, Italy. All the patients were affected by Crohn's disease and underwent surgery for an RVF under the same senior surgeon. All patients were prospectively evaluated.
  
  
  RESULTS
  All 43 patients that underwent surgery for RVF were affected by Crohn's disease. The median age was 43 years (range 21-53). Four different surgical approaches were performed: drainage and seton, rectal advacenment flap (RAF), vaginal advancement flap (VAF), transperineal approach using porcine dermal matrix (PDM), and martius flap (MF). The median time to success was six months (range 2-11). None of the patients were lost during the 18 months of follow-up. The failure group rate was 19% in contrast with the healing rate group that was 81%. No demographic of disease-related factors were found to influence healing.
  
  
  CONCLUSIONS
  The case series of this study supports the dogma that "there are no absolute rules when treating Crohn's fistula". There is no gold standard technique; however, it is mandatory to minimize the recurrence with a sphincter saving technique. Randomized trials are needed to find a standard surgical approach.
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata "PTV", Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Milito
authors.affiliation: Department of Surgery, University Hospital of Borgo Roma, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lisi
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata "PTV", Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Venditti
authors.affiliation: Department of Surgery, University Hospital of Modena, Modena, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Campanelli
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata "PTV", Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Aronadio
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata "PTV", Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Grande
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008875:Middle Aged; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery; D014621:Vagina / Q000601:surgery; D055815:Young Adult