Surgical management of complicated rectovaginal fistulas and the role of omentoplasty
| Autor: | Tobias Keck, H.-P. Bruch, Tilman Laubert, R Bouchard, M Hoffmann, M Zimmermann, C. Benecke, R. Meyer, Erik Schloericke |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Fistula medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Crohn Disease Recurrence Neoplasms Colostomy medicine Humans Colectomy Diverticulitis Aged Retrospective Studies Aged 80 and over Pelvic exenteration business.industry Mortality rate Rectovaginal Fistula Gastroenterology Middle Aged medicine.disease Colorectal surgery Pelvic Exenteration Surgery Rectovaginal fistula 030220 oncology & carcinogenesis Colitis Ulcerative Female Laparoscopy 030211 gastroenterology & hepatology Complication business Omentum Precancerous Conditions Follow-Up Studies Abdominal surgery |
| Zdroj: | Techniques in Coloproctology. 21:945-952 |
| ISSN: | 1128-045X 1123-6337 |
| Popis: | Patients with rectovaginal fistulas have a significantly reduced quality of life. Therefore, surgical therapy is often needed even in palliative cases. The aim of the present study was to perform an analysis of the results of the different treatment options available today. We performed a retrospective analysis of patients who underwent treatment for rectovaginal fistulas at the Department of Surgery, University of Schleswig–Holstein, Campus Luebeck and the Department of Surgery, WKK Heide, between January 2000 and September 2016. Complication and recurrence rate were retrospectively evaluated. The median follow-up period was 13 months (range 3–36 months). During the observation period, 58 patients underwent surgery (53 curative, 5 palliative) for rectovaginal fistulas. All patients who underwent curative surgery had an omentoplasty, and 39 of 53 (73.6%) patients underwent a resection. Thirty of 39 (77.0%) resections were low anterior resection, while non-continence-preserving resection included subtotal colectomy (n = 5), pelvic exenteration (n = 2), and proctectomy (n = 2). The fistulas were mainly secondary to inflammatory bowel disease (n = 18) or diverticulitis (n = 13), while 19 fistulas were a complication of different cancers or precancerous lesions. The median follow-up time was 13 months (range 6–36). Four patients (6.9%) had fistula recurrence (3 recurrences after low anterior resection, 1 after primary fistula closure). The mortality rate was 6.9% (n = 4). Non-resecting methods should be used only in uncomplicated fistulas. Rectovaginal fistulas secondary to inflammatory or malignant disease mostly require extensive therapy. Omentoplasty is effective for the treatment of both high and low rectovaginal fistulas. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink