Materiały źródłowe

• #1 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK535350/

  The frequency of rectovaginal fistula varies according to the cause. They are typically classified by etiology, location, and size, which affects the treatment and prognosis. […] Rectovaginal fistulas are divided into 2 groups by location: Low RVFs are located in the lower third of the rectum and the lower half of the vagina. They are closest to the anus and are repaired with a perineal surgical approach. High RVFs are located between the middle third of the rectum and the posterior vaginal fornix. They require a transabdominal surgical repair approach. […] Most RVFs are less than 2 cm in diameter and are stratified by size: Small: Less than 0.5 cm in diameter, Medium-sized: 0.5 to 2.5 cm in diameter, Large RVFs: Exceed 2.5 cm in diameter.

• #2 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193277-overview

  Among reported series, the frequency with which RVFs occur varies according to the cause. RVFs are classified on the basis of location, size, and etiology, each of which affects the treatment plan and prognosis. […] RVFs can be divided into the following two groups on the basis of location: Low RVFs, which are located between the lower third of the rectum and the lower half of the vagina, are closest to the anus and can be corrected with a perineal approach; High RVFs, which occur between the middle third of the rectum and the posterior vaginal fornix, require a transabdominal approach for repair. […] RVFs may vary greatly in size, but most are less than 2 cm in diameter. They are stratified by size as follows: Small RVFs are less than 0.5 cm in diameter; Medium-sized RVFs are 0.5-2.5 cm in diameter; Large RVFs exceed 2.5 cm in diameter.

• #3 Rectovaginal Fistula: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22260-rectovaginal-fistula

  As many as 100,000 women worldwide develop vaginal fistulas every year. Women in countries with limited medical resources are more likely to develop rectovaginal fistulas. […] The World Health Organization (WHO) estimates that 2 million females in Asia and sub-Saharan Africa have some type of untreated vaginal fistula. […] Women who have prolonged labors or undergo pelvic surgery are more likely to develop rectovaginal fistulas.

• #4 Rectovaginal Fistula | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/urogynecology/bowel-issues/rectovaginal-fistula/

  As many as 100,000 people worldwide develop vaginal fistulas every year. […] Rectovaginal fistulas can develop in a matter of days or they may form over several years. […] Appropriate care is critical. Living with symptoms of an untreated rectovaginal fistula can lead to infection, social isolation, depression or anxiety.

• #5 Vaginal fistula: Types, symptoms, and causes

  https://www.medicalnewstoday.com/articles/vaginal-fistula

  According to the World Health Organization (WHO), 50,000100,000 individuals are affected by vaginal fistulas each year. It reports that estimates suggest more than 2 million young women live with untreated vaginal fistulas in Asia and sub-Saharan Africa. […] A rectovaginal fistula describes a connection between the vagina and the rectum. This opening may result in the passage of stool and gas through the tract. Trauma during vaginal birth is the most common cause of this kind of fistula. […] To diagnose a vaginal fistula, a doctor will first review a persons medical and surgical history. […] Vaginal fistulas develop after tissue damage. Common causes include: trauma from a vaginal birth, such as vaginal tears; abdominal or pelvic surgeries, including hysterectomy and cesarean section; radiation therapy for gynecologic cancer; cancers in the pelvic area, including colon cancer, cervical cancer, and vaginal cancer; infections; chronic illnesses, such as Crohns disease and diverticulitis; a foreign body in the vagina. […] Like all major surgeries, surgical repair of vaginal fistulas comes with risks. These may include: infections, injury, bleeding, thromboembolism. […] Vaginal fistulas describe openings between the vagina and other organs, such as the rectum, bowel, and bladder, which are not normally present.

• #6 Rectovaginal fistula – Wikipedia

  https://en.wikipedia.org/wiki/Rectovaginal_fistula

  Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known as obstetric fistula), with increased risk associated with significant lacerations or interventions are used such as episiotomy or operative (forceps/vacuum extraction) deliveries or in situations where there is inadequate health care, such as in some developing countries. […] Rectovaginal fistula is said to be known as the leading cause in maternal death in developing countries. […] Rates in Eritrea are estimated as high as 350 per 100,000 vaginal births. […] Women with rectovaginal fistulae are often stigmatized in developing countries, and become outcasts.

• #7 Recto-vaginal Fistula Treatment Market a CAGR of 5.7% from 2022 to 2030 – BioSpace

  https://www.biospace.com/recto-vaginal-fistula-treatment-market-a-cagr-of-5-7-percent-from-2022-to-2030

  The frequency of recto-vaginal fistula varies according to the cause. […] Recto-vaginal fistulas are divided into two groups by location: Low RVFs are located in the lower third of the rectum and the lower half of the vagina. […] High RVFs are located between the middle third of the rectum and the posterior vaginal fornix. […] The recto-vaginal fistula treatment market in North America was valued at US$ 148.7 Mn in 2020 and is projected to reach US$ 325.8 Mn by 2031, expanding at a CAGR of 7.2% from 2021 to 2031. […] Growth of the market in the region can be attributed to favorable regulatory environment, rise in focus and interest in recto-vaginal fistula research development, and government funding for life sciences research.

• #7 Recto-vaginal Fistula Treatment Market a CAGR of 5.7% from 2022 to 2030 – BioSpace

  https://www.biospace.com/recto-vaginal-fistula-treatment-market-a-cagr-of-5-7-percent-from-2022-to-2030

  The global recto-vaginal fistula treatment market was valued at US$ 550.8 Mn in 2020. […] It is estimated to expand at a CAGR of 5.7% from 2022 to 2031. […] The rise in prevalence of Crohns disease resulting in the occurrence of recto-vaginal fistula is driving the global recto-vaginal fistula treatment market. […] Delivery-related injuries is a most common factor causing recto-vaginal fistulas. […] Hence, the incidence rate of recto-vaginal fistula is likely to increase due to rise in the rate of childbirth injuries during the forecast period. […] Presence of cancerous tumor in regions, such as uterus, rectum, vagina, anal canal or cervix, can lead to development of recto-vaginal fistula. […] Therefore, rise in prevalence of pelvic cancer and surgery in lower pelvic region are projected to drive the global recto-vaginal fistula market.

• #8 da Vinci Assisted Take Down of a Rectovaginal Fistula Through a Posterior Vaginectomy – CSurgeries

  https://csurgeries.com/video/da-vinci-assisted-take-down-of-a-rectovaginal-fistula-through-a-posterior-vaginectomy/

  A rectovaginal fistula (RVF) is an epithelial lined tract between the rectum and vagina. This can result in recurrent urinary tract or vaginal infections, but also creates a significant psychosocial burden for the patient. […] Unfortunately, due to the individual complexities of these patients, they are difficult to manage despite the numerous surgical options presently described. […] Generally RVFs are classified as low, middle or high, due to the location of the rectal and vaginal opening. […] Traditionally for high RVFs patients underwent open surgery; however, minimally invasive surgery has recently been widely accepted as the preferred approach. […] Although surgeons are becoming more facile with these approaches, both pelvic surgery and a reoperative abdomen still impose significant technical difficulties.

• #9 Proposal for Reclassification Of Rectovaginal Fistulas | CEG

  https://www.dovepress.com/rectovaginal-fistulas-not-involving-the-rectovaginal-septum-should-be–peer-reviewed-fulltext-article-CEG

  The RENISTA [REctovaginal fistulas, Not Involving Septum (RVF-II), should be Treated like Anal fistulas] concept was vindicated by the results of the study in which 27 RVF-II patients were managed like anal fistula with a high success rate (91.7%) on a median follow-up of 15 months. The fistula healed in 91.7% of patients and did not heal in 8.3% (two) patients, but this recurrence rate is acceptable in RVF, which is notorious for high recurrence rate. But, importantly, RV-septum injury or the formation of RVF-I (RVF with septum involvement) did not occur in any patient (not even in two patients who had fistula recurrence), thereby vindicating the validity of the RENISTA concept. […] The important contribution of the present study could be that the involvement of RV-septum by RVF should be utilized to classify these fistulas as RVF-I (RVF involving RV-septum) and RVF-II (RVF not involving RV-septum). RVF-II would include most low-RVF, anovaginal, and transperineal fistulas. The RENISTA (REctovaginal fistulas Not Involving Septum are Treated like Anal fistulas) concept formed the basis of treatment. RVF-I should undergo conventional RVF treatment, while its the opinion of the authors that RVF-II can be safely and conveniently treated like anal fistulas and that this can prevent any accidental injury to the RV septum in type-II patients. Finally, fistulotomy can be safely performed also in anterior fistulas provided the patient selection is judiciously done. Preoperative pelvic MRI correctly classified RVF in types I and II and showed the participation of the sphincter anal canal in participation of the fistulous tract. The use of postoperative MRI diagnosed high postoperative healing rates. More data and longer follow-ups are needed in the future to reinforce and further confirm these findings.

• #10 GMS | GMS German Medical Science — an Interdisciplinary Journal | German S3-Guideline: Rectovaginal fistula

  https://www.egms.de/en/journals/gms/2012-10/000166.shtml

  The majority of rectovaginal fistulas, 88%, are caused by obstetric trauma (postpartum rectovaginal fistula). The total number of cases corresponds to 0.1% of all vaginal births. Rectovaginal fistula occurs in 0.2-2.1% of patients with chronic inflammatory bowel disease (particularly Crohn’s disease), and following low anterior rectal resection, the frequency is as high as 10%. In recent years, rectovaginal fistula has been an increasingly common complication following hemorrhoid or pelvic floor surgery, particularly in cases where staplers or foreign materials were used. No statistics are available since the results have primarily been published in the form of case studies. […] In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based on the clinical experience of the guideline group and cannot be fully supported by the literature.

• #10 GMS | GMS German Medical Science — an Interdisciplinary Journal | German S3-Guideline: Rectovaginal fistula

  https://www.egms.de/en/journals/gms/2012-10/000166.shtml

  Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described, but evidence levels are low. The most common procedure is transrectal surgery with endorectal suture. The transperineal approach is primarily used in case of simultaneous anal sphincter reconstruction. Closure can also be achieved through the interposition of autologous tissue (Martius flap, gracilis muscle) or biomaterials. Autologous tissue is predominantly used in recurrent fistulas. In higher fistulas, abdominal approaches are also used. No specific procedure can be recommended on the basis of the literature.

• #11 German S3-Guideline: Rectovaginal fistula | Publisso

  https://books.publisso.de/index.php/en/journals/gms/volume10/000166

  The majority of rectovaginal fistulas, 88%, are caused by obstetric trauma (postpartum rectovaginal fistula). The total number of cases corresponds to 0.1% of all vaginal births. Rectovaginal fistula occurs in 0.2-2.1% of patients with chronic inflammatory bowel disease (particularly Crohn’s disease), and following low anterior rectal resection, the frequency is as high as 10%. In recent years, rectovaginal fistula has been an increasingly common complication following hemorrhoid or pelvic floor surgery, particularly in cases where staplers or foreign materials were used. No statistics are available since the results have primarily been published in the form of case studies. […] In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based on the clinical experience of the guideline group and cannot be fully supported by the literature.

• #12 Evidence – Rectovaginal fistula: Anterior levatorplasty and external sphincter plication

  https://www.webop.com/general-and-visceral-surgery/Proctology/rectovaginal-fistula-anterior-levatorplasty-and-external-sphincter-plication/evidence

  Rectovaginal fistulas make up about 5% of all anal fistulas. The overwhelming majority (88%) is due to delivery trauma and affects 0.1% of all vaginal deliveries. Further causes are chronic inflammatory bowel diseases (especially Crohn disease) with up to 2.1% and deep anterior resections with up to 10%. Rectovaginal fistulas are increasingly encountered as complications in hemorrhoidal surgery and functional pelvic floor disorders, particularly where staplers or foreign body materials are concerned. […] While most rectovaginal fistulas are traumatic in origin, other causes include inflammatory processes and postoperative complications after pelvic surgery. […] 88% of all rectovaginal fistulas are caused by traumatic vaginal dilatation with tearing of the perineum and rectovaginal septum. 5% of all vaginal deliveries result in third or fourth-degree perineal tears. Risk factors include: High birth weight; forceps delivery, especially in older pregnant women. In about 95% of the women affected, primary repair of the perineal tear, carried out immediately postpartum, results in good outcomes. 1% to 2% of all higher-grade perineal tears, dehiscence of the primary repair and inadequate care results in rectovaginal fistula.

• #12 Evidence – Rectovaginal fistula: Anterior levatorplasty and external sphincter plication

  https://www.webop.com/general-and-visceral-surgery/Proctology/rectovaginal-fistula-anterior-levatorplasty-and-external-sphincter-plication/evidence

  Rectovaginal fistulas after rectum resection are caused by iatrogenic perforation of the vagina and the use of staplers. In up to 10% of all low rectal anastomoses, e.g. in malignancy, pouch-anal anastomosis in chronic inflammatory bowel disease and proctocolectomy in polyposis coli, other risk factors include pre- or postoperative radiochemotherapy; fistula formation in up to 6.5% of cases. Most important risk factor: Use of staplers, e.g. accidental involvement of the vaginal wall after previous hysterectomy, but also anastomotic failure which results in small pelvis abscess, which then drains through the vagina. […] The diagnosis of rectovaginal fistula rests on the patients medical history and clinical examination: Discharge of air and/or mucus, possibly also stool, via the vagina. Questions about previous operations and obstetric complications are vital, as are questions about the psychological strain on the affected women.

• #13 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  In parts of the world with limited obstetrical resources, rectovaginal fistulas are common. The true incidence of rectovaginal fistulas is not readily available because the majority of series are small and much of the literature reflects a particular authors clinical experience. […] Obstetric fistulas are of two varieties. Usually, midzone fistulas are secondary to pressure necrosis of the rectovaginal septum resulting from prolonged or obstructed labor. […] Homsi and coworkers, in a review of the literature, found that episiotomy with subsequent third- and fourth-degree lacerations increased the risk for rectovaginal fistula by 4.6-fold. […] In another series, it has been reported that the incidence of rectovaginal fistula in patients with fourth-degree tears is as high as 1.5%. […] Rectovaginal fistulas are more commonly associated with Crohns disease than ulcerative colitis. Approximately 3% of patients with ulcerative colitis develop rectovaginal fistulas. […] It has been reported that up to 6% of women receiving pelvic irradiation will develop rectovaginal fistulas. […] The management of fistulas associated with Crohns disease is controversial and remains a challenge for clinicians.

• #14 A systematic review of the patient burden of Crohn’s disease-related rectovaginal and anovaginal fistulas | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-02079-8

  Crohns disease (CD)-related rectovaginal fistulas (RVFs) and anovaginal fistulas (AVFs) are rare, debilitating conditions that present a substantial disease and treatment burden for women. […] Few epidemiology studies were identified, with one study estimating the prevalence of RVF to be 2.3% in females with Crohns disease. […] Despite RVF and AVF being debilitating conditions, there is limited observational literature on the epidemiology and disease burden of these conditions. […] We found that very few population-based epidemiology studies have been published; however, one Netherlands-based study estimates the prevalence of RVF to be 2.3% among female patients with CD. […] A notable gap in the literature is the lack of precise definitions and standardized use of terminology throughout studies. […] The addition of more robust, population-based studies and registry studies would contribute to the current knowledge gap around the epidemiology of RVF and AVF globally and could be a potential topic for further research.

• #15 Rectovaginal fistula after low anterior resection: Prevention and management

  https://www.wjgnet.com/1948-9366/full/v13/i8/764.htm

  Rectovaginal fistula after low anterior resection for rectal malignancy is one of the most challenging postoperative complications because it is difficult to treat and may complicate plans of adjuvant therapy. […] This article presents a comprehensive overview of the incidence, risk factors, management and outcome of RVF after low anterior resection. Preventive strategies and a management algorithm are also discussed. […] The incidence of RVF after low anterior resection for rectal cancer is reported as 1.6%-5.1%. […] It was well evident that low colorectal anastomosis, especially within 5 cm from the anal verge, is an important risk factor for RVF after sphincter-preserving operations. […] The diagnosis of RVF after low anterior resection is not difficult because it is well characterized by postoperative passage of flatus or stool through the vagina, in most cases.

• #16 Long-Term Complications Of Rectovestibular Fistula And Rectovaginal Fistulas

  https://drgursev.com/long-term-complications-of-rectovestibular-fistula-and-rectovaginal-fistulas/

  Rectovaginal and rectovestibular fistulas can be caused due to various reasons and they are only found in female patients. […] The exact reason behind congenital rectovaginal rectovestibular fistulas is still unknown; however, medical experts suggest that it might be caused by certain prescribed drugs, diet or the environment of the mother. […] Rectovaginal fistula can be caused in adults due to various reasons such as complications during childbirth, inflammatory bowel disease or complications during pelvis surgery. […] Cancer and its treatment in the vagina, cervix, rectum, uterus, or anus can also cause small holes in the nearby organs, leading to rectovaginal rectovestibular fistula. […] Congenital rectovestibular fistula and rectovaginal fistulas are not life-threatening diseases; however, they can cause various issues for the child in the long run.

• #16 Long-Term Complications Of Rectovestibular Fistula And Rectovaginal Fistulas

  https://drgursev.com/long-term-complications-of-rectovestibular-fistula-and-rectovaginal-fistulas/

  If these fistulas are not diagnosed and treated early, they can cause irritation, severely impact the patients self-esteem and decrease the quality of life. […] These rectovestibular fistula concerns will not go away on their own and will stay well into adulthood if not treated in time. […] Not treating the rectovaginal or rectovestibular fistula can have many long-term effects on the patients daily life which can degrade the patients mental and emotional health. […] Recognising and addressing these rectovestibular fistula challenges and concerns early can improve the patients quality of life and prevent long-term health risks.

• #17 A Problematic Peril of Pessaries: The Rare Case of Rectovaginal Fistulas Resulting From Pessary Use | Gordon | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/308/172

  The risk for major complication such as fistula formation from pessaries is believed to be low, but this may be due to under reporting in the literature. An extensive literature search revealed a total of eight reported cases of recto-vaginal fistulas secondary to pessary usage. The age range for the reported cases was 70 – 88 years old. Of interesting note, almost all of the reported cases in the literature were associated with the use of either a Gellhorn or shelf pessary. A possible cause of fistula formation following the use of a pessary could be due to a poorly fit pessary that may cause excessive mechanical force on the adjacent tissue and lead to erosion. It is possible that the general structure and design of the shelf and Gellhorn pessary, causes a disproportionate amount of pressure at the stem/dish into the vaginal wall leading to an increase in the risk of anterior and posterior wall erosions. Prolonged unattended pessaries also are at increased risk of fistula formation.

• #18 Consensual Postcoital Rectovaginal Fistula | Rohatgi | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/363/216

  Consenting sexual intercourse (CSI) leading to rectovaginal fistula (RVF) is a rare event. However, its incidence is on the rise. […] A rectovaginal fistula (RVF) is an abnormal communication between the rectum and vagina. They are rare and majorities are of traumatic origin (obstetric/surgical incidents). […] Recently more cases of RVF are being reported following CVI either due to increase in consensual sex due to change in life style, stress and strain of life, consenting sex being considered physiological and awareness. […] RVF following CSI is a rare, devastating event. These women need to be seen by a senior gynecologist/surgeon in an emergency setting. A detailed sexual history/clinical examination provides clue to the etiology. Timely diagnosis and management result in optimum outcome. However, these individuals require counselling and psychological support to prevent negative impact on their future sexual functioning.

• #19 Vaginal Fistula Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/obgyn/services/fistula-care

  The most common fistula seen in the United States is a rectovaginal fistula, which is an opening between the rectum and vagina and is usually caused by complicated childbirth. […] We diagnose a rectovaginal fistula through a vaginal and rectal exam. If we need more information to be certain, we conduct a barium enema or CAT scan with oral and rectal contrast. […] We treat rectovaginal fistula by performing a multi-layer repair of the area between the rectum and the vagina. Most women have enough tissue in this area that we can place multiple layers between the previous defects in the rectum and the vagina to ensure that the fistula does not return.

• #20 Rectovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/rectovaginal-fistula?lang=us

  Rectovaginal fistulae are a type of colovaginal fistula where there is an abnormal fistulous connection between the rectum and the vagina. It is considered the most common gastrointestinal fistula involving the female genital tract 1. […] They can occur from a number of causes that include: complication of childbirth, pelvic malignancy, pelvic radiation therapy, infectious processes within the rectovaginal septum, operative trauma, inflammatory bowel disease, e.g. Crohn disease, foreign body complication. […] Endoluminal sonography and endoluminal MR imaging are thought to have comparable positive predictive values in revealing the location of rectovaginal fistulas 2.

• #21 Top Published Expert Doctors for Rectovaginal Fistula

  https://findexpertmd.com/d/Rectovaginal_Fistula

  301 top medical experts on Rectovaginal Fistula across 52 countries and 23 U.S. states, including 164 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials ClinicalTrials.gov: at least 11 including 5 Completed, 4 Recruiting.

• #22 How fistulas impacted my health, and my life

  https://crohnsandcolitis.org.uk/news-stories/blog-posts/how-fistulas-impacted-my-health-and-my-life

  Rectovaginal fistulas impacted Rachael’s health, both physically and mentally, and it was a long journey to get to where she is today and achieve her PhD. […] A rectovaginal fistula is an abnormal connection between the rectum and the vagina. Fistulas can allow wind and faecal matter to pass through the vagina and cause infections, soreness, discharge, and abscesses. […] Living with Crohns and a fistula doesn’t just affect a person’s physical health but their mental and emotional health too. […] Rectovaginal fistulas can be terribly embarrassing and because of this good information, empathy and support are scant.

• #23 :: astr.or.kr :: Annals of Surgical Treatment and Research

  https://astr.or.kr/DOIx.php?id=10.4174/astr.2019.97.3.149

  Rectovaginal fistula can result from various causes and diverse surgical procedures have developed as a result. […] The most common cause was radiation therapy, followed by pelvic operation, birth injury, perineal operation, cancer invasion, and trauma. […] Radiation therapy and pelvic operation as cause of fistula were significantly poor prognostic factors (P = 0.010, P = 0.045) and Crohn disease had a tendency for poor prognostic factors (P = 0.058). […] An individualized approach and repeated surgeries with complex or newly developed procedures, even among high-risk causes of fistula, may be necessary to achieve successful closure. […] The purpose of this study was to investigate the outcome of surgical treatments for RVF according to the various causes and procedures and to analyze the prognostic factors for successful RVF closure.

• #23 :: astr.or.kr :: Annals of Surgical Treatment and Research

  https://astr.or.kr/DOIx.php?id=10.4174/astr.2019.97.3.149

  The most common cause of fistula was radiation therapy (RT) for cancer (n = 27 [29.3%]). […] The clinical characteristics and causes of fistula are presented in Table 1. According to the location of fistula opening, low fistulas were significantly related to pelvic operation, birth injury, and perineal operations (P = 0.007, P = 0.001, P = 0.012), and high fistulas were significantly related to RT and cancer invasion (P 0.001, P = 0.002). […] In univariate analysis, RT was a significantly poor prognostic factor, but low fistula, sphincter defect, birth injury as cause of the fistula were good prognostic factors for successful closure. […] The success rates obtained in previous studies have been diverse, ranging from 30% to approximately 90%, because the patients presented with various causes of RVF and a variety of surgical procedures were used. […] The cause of RVF was the most important prognostic factor for successful closure.

• #24 Perioperative adverse events in women undergoing rectovaginal fistula repair in the United States – Chang – Gynecology and Pelvic Medicine

  https://gpm.amegroups.org/article/view/7048/html

  In this study, the incidence of complications associated with any RVF repair was 13%. The abdominal approach to the RVF repair was associated with a higher incidence of postoperative complications. […] The overall incidence of complications was 13% (98/752). The abdominal approach was associated with a higher incidence of postoperative complications (23.0% vs. 7.5%, P0.001) and a higher readmission rate (12.6% vs. 6.2%, P=0.006) when compared to the vaginal and transanal approach. […] In this large cross-sectional population-based cohort study, we found that incidence of complications after a RVF repair was 13%. Women with a RVF repair by the abdominal approach had nearly 3 times the odds to develop an adverse event, when compared to those with surgery via the vaginal and transanal approach. […] Whenever possible, a transvaginal or transanal approach to RVF repair should be taken to mitigate the risk of associated complications.

• #25 Minimally invasive endoscopic repair of rectovaginal fistula

  https://www.wjgnet.com/1948-9366/full/v14/i9/1049.htm

  Surgical techniques for repair of rectovaginal fistula (RVF) have been continually developed, but the ideal procedure remains unclear. […] Endoscopic repair is a novel and minimally invasive technique for RVF repair with increasing reporting. […] The current status of minimally invasive endoscopic repair for rectovaginal fistulas (RVFs) was reviewed. […] Endoscopic repair is recommended as a novel and promising technique for RVF and warrants consideration by surgeons. […] The endoscopic repair of RVF is in constant development, including several available approaches. The preliminary effectiveness of endoscopic technique for RVF repair is acceptable. […] Endoscopic repair for RVF is novel, effective and promising with acceptable preliminary effectiveness. […] Endoscopic repair for RVFs is novel, effective and promising.

• #25 Minimally invasive endoscopic repair of rectovaginal fistula

  https://www.wjgnet.com/1948-9366/full/v14/i9/1049.htm

  The successful closure rates for RVF surgical repair vary in the literature. […] Endoscopic repair is considered a viable minimally invasive approach. […] The minimally invasive endoscopic approach for RVF repair is a promising choice, and more surgical methods could be developed based on the endoscopic technique.

• #26 Predictors of Outcome of Rectovaginal Fistula Surgery in Women With Crohn’s Disease | Manne | Journal of Clinical Medicine Research

  https://www.jocmr.org/index.php/JOCMR/article/view/2421/1365

  Despite measures taken to control traditional risk factors like increased rectal disease activity, anorectal stenosis, and, to a lesser extent, obesity, rates of poor outcomes after rectovaginal fistula (RVF) surgery in women with Crohns disease (CD) are still high and require further elucidation. […] We sought to identify other risk factors that may be associated with poor outcome in these patients. […] The literature highlights the propensity for CD-related RVF to recur, and more troubling still, surgical intervention in CD patients with recurrent RVF fails 50% of the time, compared with a 9% failure rate in patients suffering from RVF of non-CD origin. […] Our study adds to the growing concern in the literature that surgery, specifically mucosal flap advancement, is perhaps preemptively performed and highlights the importance of maximum medical management in CD complicated with RVF.

• #27

  https://journals.lww.com/ajg/fulltext/2024/10001/s3172_a_rectovaginal_fistula_associated_with.3173.aspx

  Rectovaginal fistulas (RVFs), aberrant tracts connecting the rectum to the vagina, often occur as a post-surgical or obstetric complication, from inflammatory conditions such as diverticulitis or Crohns disease, or from malignancies. […] Malignancies arising from RVFs specifically are not well described. […] Chronic inflammation is a risk factor for the development of malignancy, however, fistula associated malignancy is uncommon. […] RVFs should not be overlooked as a potential site for the development of cancer. […] Early suspicion and diagnosis is crucial, a mean time to malignancy from diagnosis of a RVF has not been determined. […] In patients with RVFs with new, worsening, or refractory symptoms, malignancy should be suspected and evaluated with early imaging and endoscopic ultrasound with biopsy. […] Further research is needed to establish screening guidelines in select patient populations.

Zobacz więcej