Long-Term Outcomes of Surgical Treatments for Rectovaginal Fistula in 100 Consecutive

Objective: To evaluate the long-term outcomes of rectovaginal fistula (RVF) repair techniques at a single tertiary center, and to identify which procedure is the most appropriate on a case-by-case basis by providing a structured algorithm.
Background: Numerous surgical options are available to treat RVF, and success factors remain unknown.
Methods: All consecutive females over 18 years with RVF who were treated at our center between 2003 and 2019 were included. Data on patients’ characteristics, etiology, surgeries performed, and their final outcome were collected. The primary outcome was success of RVF repair. Patients who had absence of vaginal fecal or gas discharge in the 6 months after the last surgical intervention were considered healed. Those who were healed and had no permanent fecal diversion were considered to be successful. The secondary objective was to identify the prognostic factors for success.
Results: Hundred females were included. The most common cause of RVF was postoperative (27%), postpartum (23%), Crohn’s disease (20%), and post radiotherapy (9%). A total of 379 procedures were performed. The healing rate without permanent stoma was 60%. In univariate analysis, RVF related to Crohn’s disease (p = 0.011) and radiation therapy (p = 0.015) were related to worse outcomes. Creation of a stoma was the only significant factor (p = 0.002) in multivariate analysis.
Conclusion: Fecal diversion early in the management of RVF is particularly important when dealing with etiologies that worsen tissue healing. A structured algorithm could help to standardize protocols and improve surgical outcomes.