A single-center retrospective analysis of endorectal advancement flaps used for the treatment of simple rectovaginal fistulas.

Abstract

Objective: To investigate the effectiveness of endorectal advancement flaps for middle and low rectovaginal fistulas.

Methods: A retrospective cohort of 57 patients who underwent surgery via an endorectal advancement flap in the RVF between July 2007 and March 2022 was generated. The clinical features of the patients were reviewed. The associations between fistula closure and diverse clinical parameters, including age, body mass index, diameter of the fistula, prior repair, pathological type, diverting stoma and operative method, were analyzed.

Results: Congenital (n = 19, 33.33%) and obstetric (n = 19, 33.33%) injuries were the most common etiologies of rectovaginal fistulas. The success rate in patients who underwent a first repair was 66.7%, and the overall success rate was 70.2% after repetition of the same technique. There were no significant differences in the closure rate between the success and failure groups in age, body mass index, prior repair, preoperative colostomy, or pathological type (p > 0.05). However, a diameter greater than 1 cm predicted a lower success rate for both the first repair (p < 0.05) and the overall procedure (p < 0.05). Two cases of failure with a diameter greater than 1 cm succeeded after a sphincter repair procedure half a year later.

Conclusion: The endorectal advancement flap is safe and effective for removing simple rectovaginal fistulas at the middle and lower positions. A diameter greater than 1 cm is an independent risk factor for this surgical technique, and sphincteroplasty may be a better choice for this condition.