Rectovaginal fistulas, outcomes of various surgical repair and predictive factors of healing success. A retrospective cohort study of 40 cases

Abstract

BackgroundRectovaginal fistulas causing distressing and irritating symptoms as well as psychological suffering to the patients. Objectivethe main objective is to assess the outcomes of surgical repair of rectovaginal fistulas and factors that predict repair failure. MethodsA retrospective cohort study in which 40 patients presented with rectovaginal fistulas were included. Their clinical presentations and the management outcomes of various surgical repair were studied and analyzed. The predictive factors for successful surgical repair were investigated and addressed. ResultsThe overall success rate of both local and trans-abdominal was 82.5%.The success rate of local repairs was 87.5% while the success rate of Tran's abdominal repairs was 50%. Fecal diversion was done for 9 patients with complex high type fistulas. The results showed that 6 patients were healed and 3 patients with diverting colostomy were failed to heal after stoma reversal. Thus the role of diverting colostomy in recto-vaginal fistulas healing was not significant. (P > 0.05). The main negative predictor factors were prior repair and etiology of the fistulas. ConclusionsFor low simple rectovaginal fistulas, local repair is preferred option. Complex, high type and recurrent fistulas necessitate trans-abdominal approach. History of prior surgical repair and etiology are the main risk factor for repair failure. Diverting colostomy did not increase the overall healing rate.