Abstract
PURPOSE: Rectovaginal fistula (RVF) repair can be challenging. Additionally women may experience sexual dysfunction and psychosocial ramifications even after a successful repair. The aim of this study was to investigate variables looking for predictors of healing/failure and examine long-term quality-of-life (QOL) and sexual function in women with low RVF from obstetrical or cryptogladular etiology. METHODS: From June 1997-2009, 268 women underwent RVF repair. Of those, 100 with obstetric or cryptoglandular etiology agreed to participate in this study. Healing, type of procedure, use of seton or stoma, number of previous procedures, smoking, age, body mass index (BMI), dyspareunia, QOL using SF12, FIQL, IBD-QOL and Female Sexual Function Index was obtained from our prospective database and telephone contact. Fisher's-exact test, chi-square test, and MultivariableLogistic-Regression-Model were used to identify the variables associated with healing/failure. RESULTS: Mean follow-up was 45.8±39.2 months; mean age 42.7 ±10.5 years; and BMI was 28.8±7.6. Sixty (60%) fistulas were obstetric and 40 (40%) cryptoglandular. 68/100 patients (68%) healed. On multivariate analysis, treatment failure was related to a heavier BMI (p=0.001) and number of repairs (p=0.02). Looking at each type of repair, episioproctotomy had significant healing compared to the other choices (but was not significant on multivariate analysis). Forty-seven women were sexually active at follow-up. 12/47 (25.5%) reported dyspareunia. Fecal incontinence was reported preoperatively in 42 women, more often in those with obstetric related-RVF (73% vs. 28% p>0.05). Healing was not affected by age, smoking, co-morbidities, preoperative seton or stoma use. Fecal and sexual function and QOL were comparable between women with healed and unhealed RVF.CONCLUSION: Patients with higher BMI and more repairs had decreased healing rates following RVF repair. Despite surgical outcome, QOL and sexual function were surprisingly similar regardless of fistula healing.
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