Long-term results of the Musset surgical technique in the treatment of recto-vaginal fistulas.

Objective: Recto-vaginal fistulas (RVF) are a rare pathology, mostly affecting developing countries. They are mainly obstetrical (88% of cases) and have an incidence of 0.5%. Musset's surgical technique in the management of RVF has been the subject of few studies and there is little data in the literature concerning the evaluation of its long-term efficiency and its morbidity. The aim of our study was to investigate the long-term results of patients who underwent Musset's surgery for cure of RVF.

Methods: We conducted a monocentric cohort study between January 1, 2002, and December 31, 2020 including patients who had undergone a RVF cure by the Musset technique. These patients were recalled in consultation to be examined and completed a questionnaire designed for this study with validated functional and quality-of-life scores. For patients who did not respond to this solicitation, information was retrieved from their postoperative consultations in their medical records. The surgical technique was considered successful if the patient did not present gas or stool incontinence postoperatively.

Results: A total of 38 patients had RVF repair surgery by the Musset technique, and the technique was successful in 48.4% of cases, with high complication and reintervention rates (54.8% and 35.7%, respectively). Half of the patients had a recurrence of symptoms (51.6%) with mainly gas incontinence (43.8%). A total of 11 patients had a long-term evaluation (28.9%) with a median follow-up of 5 years (4-15.5 years). Among the patients that were re-evaluated, all had felt that their life had improved postoperatively and were satisfied with the intervention with a median PGI-I score of 1 (1-1.5). According to the surveys, quality-of-life was improved postoperatively with a median Cleveland score decreasing from 2.5 (1.5-3.75) to 0.5 (0-3.75) and there were no limitations due to physical health or emotional problems according to the SF-36 questionnaire. Patients had satisfactory sexual intercourses after the procedure with a median high score of 5.2/6 according to the FSFI questionnaire.

Conclusion: The Musset technique provides good functional results and high satisfaction rates and is associated with improved quality-of-life postoperatively. However, it is also associated with a high rate of complications and reinterventions. Treatment of RVF can be long and complicated and should therefore be done in referral centers in order to optimize the results.