Recto-vaginal fistulas of obstetrical origin: Epidemiological aspects and therapeutic approaches in the general surgery department of the Idrissa POUYE general hospital

Abstract

Introduction: The recto-vaginal fistula is a pathological communication between the posterior wall of the vagina and the anterior wall of the rectum, through the recto-vaginal septum. Fistulas of obstetric origin remain common in developing countries. Aim: To describe the epidemiological aspects of obstetric rectovaginal fistulas in our department and discuss the results of treatment.Patients and methods: Retrospective multicentre study from January 1, 2014 to December 31, 2022, collecting 13 cases of obstetrical rectovaginal fistula treated in the general surgery department of the Idrissa POUYE general hospital. Results: The median diameter of the fistula was 12 mm. The treatment had consisted́ of a suture excision in 1 patient. A perineotomy with simultaneous reconstruction in 2 cases; a perineotomy and two-stage reconstruction according to Musset in 10 cases. Complete healing after the first operation was found in 10 cases, complete healing but at the cost of dyspareunia was noted in 1 case. A definitive failure was found in 2 cases. Conclusion: Obstetric RVFs are rare but they have not completely disappeared in Senegal despite the efforts made. The 2-stage surgical treatment according to MUSSET gives good results but the best treatment remains preventive because of the serious socio-economic repercussions of this pathology.