Characteristics, management, and outcomes of repair of rectovaginal fistula among 1100 consecutive cases of female genital tract fistula in Ethiopia.

Abstract

To characterize the incidence, presentation, management, and outcomes of rectovaginal fistula (RVF) in Ethiopia. In a retrospective study, demographic and clinical data were obtained for all women with genital tract fistulas admitted to the Barhirdar Hamlin Fistula Hospital, Ethiopia, for fistula repair surgery between January 2005 and October 2008. Of 1100 cases, 1057 were suitable for analysis. Vesicovaginal fistula (VVF) without RVF was present in 933 (88.3%) cases, combined VVF and RVF in 79 (7.5%), and isolated RVF in 45 (4.3%). Only 4 (0.4%) women had isolated RVFs that could be attributed to prolonged obstructed labor; the remaining 41 RVFs were due to trauma (including sexual trauma), iatrogenic causes, infection, perineal tears, or previous failed repairs. All RVFs were managed with a flap-splitting operative technique, without grafts or diverting colostomies. Overall, 120 (98.4%) of 122 RVFs repaired at the study hospital remained closed at discharge. Combined VVF and RVF was associated with a longer labor (P<0.001), more stillbirths (P=0.028), a larger and lower VVF (P<0.001 for both), and more vaginal scarring than was isolated VVF (P<0.001). An obstetric RVF represents a more severe injury process than does a VVF. RVFs rarely occur without a VVF if due to obstructed labor. However, they can be managed successfully without diverting colostomies or grafts.