Abstract
PurposeRadiation-induced rectovaginal fistula (RI-RVF) is a chronic and serious condition with a significant influence on quality of life. The aim of this study is to evaluate the results of surgical treatment of rectovaginal fistulas of patients previously undergoing radiotherapy.MethodsFifty patients treated in the Gynaecological Radiotherapy Unit for gynaecologic malignancy and in the Department of General and Colorectal Surgery for RI-RVF between 2003 and 2013 were enrolled into a prospectively maintained database and underwent regular follow-up examinations in an outpatient clinic, during which surgical outcomes were assessed.ResultsMedian age was 60 years (range 40–84 years). Cervical cancer was the most common cause of radiotherapy. Median time of fistula development after radiotherapy was 20 months (range 5–240 months). In 48 (96%) patients, only faecal diversion could be performed, while two patients underwent rectal resection. The fistula healed in six patients. Factors that correlated with fistula healing were a distance from the anal verge above 7 cm (p = 0.007 OR 18 95%CI 2.2609–14.3062) and creation of loop ileostomy (p = 0.08 OR 17 95%CI 1.2818–23.9701), whereas a prolonged course of radiotherapy of more than 6 weeks (p = 0.047) correlated negatively. In multivariate analysis, only distance from the anal verge remained significant (p = 0.031 OR 2.35 95%CI 1.0422–5.2924).ConclusionsThe treatment of radiation-induced rectovaginal fistulas needs to be tailored individually to each patient. Faecal diversion remains the simplest and safest method of treating RI-RVF, especially in the group of patients who cannot undergo complicated surgical procedures, and offers acceptable quality of life.
Highlights
Rectovaginal fistula is a serious anorectal condition with a significant impact on patient quality of life
New options of surgical treatment have been introduced or rediscovered, enabling improved treatment results, especially when dealing with low fistulas [1, 2]. Such progress has not been observed in the field of Crohn-related and radiation-induced RVF (RI-RVF), where the inflammatory response and fibrosis of surrounding tissue limits the possibilities of tissue healing, decreasing the number of possible interventions [3,4,5]
Each patient referred to the department with a diagnosis of radiation-induced rectovaginal fistula was carefully examined by a team of two colorectal surgeons to confirm the presence of RI-RVF and classify it, based on diameter and distance from the anal margins, using a rectoscope
Summary
Rectovaginal fistula is a serious anorectal condition with a significant impact on patient quality of life. New options of surgical treatment have been introduced or rediscovered, enabling improved treatment results, especially when dealing with low fistulas [1, 2]. Such progress has not been observed in the field of Crohn-related and radiation-induced RVF (RI-RVF), where the inflammatory response and fibrosis of surrounding tissue limits the possibilities of tissue healing, decreasing the number of possible interventions [3,4,5].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
