Postoperative rectovaginal fistula: stoma may not be necessary-a French retrospective cohort.

Autor: Poitevin M; Department of Medicine, University of Health, Angers, France.; Department of Visceral Surgery, CHU Angers (Angers University Hospital), University of Angers, 9, Angers, Cedex, France., Hamel JF; Department of Visceral Surgery, CHU Angers (Angers University Hospital), University of Angers, 9, Angers, Cedex, France.; Department of Biostatistics, La Maison de La Recherche, University Hospital of Angers, 9, Angers, Cedex, France., Ngoma M; Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Service de Proctologie Médico-Chirurgicale, Paris, France., Brochard C; Unité D'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France.; Unité de Proctologie, CHU Rennes Pontchaillou, Service Des Maladies de L'appareil Digestif, Rennes, France., Duchalais E; Department of Digestive Surgery, University Hospital of Nantes, Nantes, France., Siproudhis L; Unité D'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France.; Unité de Proctologie, CHU Rennes Pontchaillou, Service Des Maladies de L'appareil Digestif, Rennes, France., Faucheron JL; UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, VetAgro Sup, 38000, Grenoble, France.; Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France., de Parades V; Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Service de Proctologie Médico-Chirurgicale, Paris, France., Alves A; Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.; UMR INSERM U1086 Anticipe, Centre François Baclesse, Caen, Cedex, France., Cotte E; Department of Digestive Surgery, Hôpital Lyon Sud, CHU Lyon, Cedex, France.; Faculty of Medicine of Lyon Sud-Charles Mérieux, University Lyon 1, Cedex, France., Ouaissi M; Department of Digestive, Oncological, Endocrine, Hepato-Biliary Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France., Bridoux V; Department of Digestive Surgery, Rouen University Hospital, Rouen, France., Corbière L; Department of Digestive Surgery, CHU Rennes Pontchaillou, Rennes, France., Ortega-Deballon P; Department of Digestive Surgery, Dijon University Hospital, Dijon, France., Abo-Alhassan F; Department of Digestive Surgery, Dijon University Hospital, Dijon, France., Trilling B; UMR 5525, Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, VetAgro Sup, 38000, Grenoble, France.; Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France., Venara A; Department of Medicine, University of Health, Angers, France. auvenara@chu-angers.fr.; Department of Visceral Surgery, CHU Angers (Angers University Hospital), University of Angers, 9, Angers, Cedex, France. auvenara@chu-angers.fr.; SFR ICAT, CHU Angers, HIFIH, University of Angers, 9, Angers, Cedex, France. auvenara@chu-angers.fr.
Jazyk: angličtina
Zdroj: Techniques in coloproctology [Tech Coloproctol] 2024 Oct 03; Vol. 28 (1), pp. 138. Date of Electronic Publication: 2024 Oct 03.
DOI: 10.1007/s10151-024-03013-2
Abstrakt: Background: Postoperative rectovaginal fistula leads to a loss of patients' quality of life and presents significant challenges to the surgeon. The literature focusing specifically on postoperative rectovaginal fistulas is limited. The objective of the present study is to identify factors that can enhance the success of the management of this postoperative rectovaginal fistula.
Methods: This retrospective multicentric study included all patients undergoing surgery for rectovaginal fistulas, excluding those for whom the etiology of rectovaginal fistula was not postoperative. The major outcome measure was the success of the procedure.
Results: A total of 82 patients with postsurgical fistulas were identified, of whom 70 were successfully treated, giving a success rate of 85.4%. On average, these patients required 3.04 ± 2.72 interventions. The creation of a diversion stoma did not increase the success rate of management [odds ratio (OR) = 0.488; 95% confidence interval (CI) 0.107-2.220]. Among the 217 procedures performed, 69 were successful, accounting for a 31.8% success rate. The number of interventions and the creation of a diversion stoma did not correlate with the success of management. However, direct coloanal anastomosis was significantly associated with success (OR = 35.06; 95% CI 1.271-997.603; p = 0.036) as compared with endorectal advancement flap (ERAF). Other procedures such as Martius flap did not show a significantly higher success rate.
Conclusion: The creation of a diversion stoma is not necessary in closing a fistula. ERAF should be considered as a first-line treatment prior to proposing more invasive approach such as direct coloanal anastomosis.
(© 2024. The Author(s).)
Databáze: MEDLINE
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