Experience with Different Surgical Procedures in Recto-Vaginal Fistula Management

Abstract

Background and Objective: Recto-vaginal fistula (RVF) is the most distressing surgical condition that a woman can experience. Obstetric trauma is the cause of upto 88% of RVFs. The second commonest cause of RVF is Crohn's disease; upto 10% of women with Crohn's disease will develop an RVF. Other causes include radiation, malignancy, iatrogenic injury and infection. The surgical treatment is the standard of care in most females who had persistent fistula with symptoms. However, conservative management is considered in mild cases. The present study designed to search for the optimal surgical management of Recto-vaginal-fistula. Methodology: From January, 1995-January, 2015, 118 patients with RVF were referred to the department (Ministry of Health hospitals, Health Insurance hospitals and Al-Azhar University hospital New Damietta. All patients were subjected to full clinical evaluation, laboratory studies, contrast radiography, ultrasound examination and some with computed tomography (CT) and magnetic resonance image (MRI) with contrast studies. All patients underwent clinical interview including wexner incontinence score (WSI) and Female Sexual Functional Index (FSFI) in addition to Anorectal manometry studies. Result(s): Surgical treatments were simple fistulectomy (37 cases), rectal advancement flap (18 cases), single incision trans-perineal repair (24 cases), trans-abdominal approach with primary resection anastomosis (20 cases) and trans-abdominal approach with colostomy (19 cases). Clinical success was achieved in 108 cases (91.5%), 10 cases of recurrence (8.5%), 9 cases with wound infections and edema (7.6%), 4 cases with colostomy complications (3.4%), 3 cases with perineal abscesses (2.5%), 2 cases with hematoma (1.7%) and 1 case (0.8%) with postoperative dysparonia. Conclusion(s): It was concluded that the optimal surgical technique does not exist and treatment should be individualized.Copyright © 2017 Gamal EL-Maadawy et al.