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

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2024-10-03 DOI:10.1007/s10151-024-03013-2

Maëlig Poitevin, Jean-Francois Hamel, Marie Ngoma, Charlène Brochard, Emilie Duchalais, Laurent Siproudhis, Jean-Luc Faucheron, Vincent de Parades, Arnaud Alves, Eddy Cotte, Mehdi Ouaissi, Valérie Bridoux, Lisa Corbière, Pablo Ortega-Deballon, Fawaz Abo-Alhassan, Bertrand Trilling, Aurélien Venara

{"title":"Postoperative rectovaginal fistula: stoma may not be necessary-a French retrospective cohort.","authors":"Maëlig Poitevin, Jean-Francois Hamel, Marie Ngoma, Charlène Brochard, Emilie Duchalais, Laurent Siproudhis, Jean-Luc Faucheron, Vincent de Parades, Arnaud Alves, Eddy Cotte, Mehdi Ouaissi, Valérie Bridoux, Lisa Corbière, Pablo Ortega-Deballon, Fawaz Abo-Alhassan, Bertrand Trilling, Aurélien Venara","doi":"10.1007/s10151-024-03013-2","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"138"},"PeriodicalIF":2.7000,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450074/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-024-03013-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

术后直肠阴道瘘：可能不需要造口--法国回顾性队列。

背景：术后直肠阴道瘘会导致患者生活质量下降，并给外科医生带来巨大挑战。专门针对术后直肠阴道瘘的文献十分有限。本研究的目的是找出能提高术后直肠阴道瘘治疗成功率的因素：这项回顾性多中心研究纳入了所有接受直肠阴道瘘手术的患者，但不包括直肠阴道瘘病因并非术后的患者。主要结果指标为手术的成功率：结果：共发现 82 例手术后瘘管患者，其中 70 例治疗成功，成功率为 85.4%。这些患者平均需要 3.04 ± 2.72 次干预。建立分流造口并不会提高治疗成功率[几率比（OR）=0.488；95% 置信区间（CI）0.107-2.220]。在 217 例手术中，69 例成功，成功率为 31.8%。介入治疗的次数和分流造口的创建与治疗的成功率无关。不过，与肛门直肠内推进皮瓣（ERAF）相比，直接结肠肛门吻合术与成功率有显著相关性（OR = 35.06；95% CI 1.271-997.603；P = 0.036）。结论：结论：在闭合瘘管的过程中，并不需要创建分流造口。结论：在关闭瘘管的过程中，不一定要创建分流造口，ERAF 应被视为一线治疗方法，然后再考虑采用更具侵入性的方法，如直接结肠肛门吻合术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.