International Conference on Reproduction and Fertility October 18-19, 2018 Abu Dhabi, UAE
October 18-19, 2018 Abu Dhabi, UAE
A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Passage of gas, stool or pus from the vagina. Foul-smelling vaginal discharge. Recurrent vaginal or urinary tract infections. Irritation or pain in the vulva, vagina and the area between the vagina and anus (perineum) Pain during sexual intercourse.
After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix. A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.
Seventy-nine patients presented RVF due to Crohn disease in 34 (43%), postoperative in 25 (32%), obstetrical in 7 (9%), radiation proctitis in 4 (5%), and miscellaneous in 9 (11%). A total of 286 procedures (132 with associated stoma, 46%) were performed including 217 conservative (76%) [seton drainage (n?=?59; 21%), vaginal (n?=?49, 17%) or rectal advancement flap (n?=?46; 16%), diverting stoma only (n?=?27; 9%), plug (n?=?15; 5%), glue (n?=?13; 5%), or others (n?=?8, 3%)]; and 69 major procedures (24%) [gracilis muscle interposition (n?=?32; 11%), coloanal or colorectal anastomosis (n?=?19; 7%) including 11 delayed anastomosis with colonic pull-through, biomesh interposition (n?=?9, 3%), and abdominoperineal resection (n?=?9; 3%)]. After a mean follow-up of 33 months, overall success rate was 57 of 79 (72%). Per-procedure-based multivariate analysis identified major procedure [odds ratio (OR): 6.4 (2.9–14.2); P?<?0.001], diverting stoma, less than 9 months between diagnosis and first surgery [OR: 2.3, and first surgery in our institution; P?=?0.003], as independent factors for success.