Schwandner O, Fuerst A, Kunstreich K, Scherer R
Department of Surgery and Pelvic Floor Center, Caritas-Krankenhaus St. Josef, Regensburg, Germany.
Tech Coloproctol. 2009 Jun;13(2):135-40. doi: 10.1007/s10151-009-0470-x. Epub 2009 May 29.
The aim of this prospective study was to analyse the efficacy of Surgisis mesh for closure of rectovaginal fistulas. Prospective data were collected from two centres.
All patients with a rectovaginal fistula who underwent definitive surgery using Surgisis mesh were prospectively enrolled in this study. Inclusion criteria included a rectovaginal fistula in the lower two-thirds of the rectovaginal septum. Surgery was performed with a standardized technique including combined transrectal and transvaginal excision of the rectovaginal fistula with transvaginal placement of the mesh. Success was defined as closure of both internal and external (perianal and vaginal) openings, absence of drainage without further intervention, and no abscess formation.
Over a period of 16 months, a total of 21 mesh procedures were performed in two centres. The mean age of the patients was 47 years (18-59 years). Of the 21 patients, 18 (86%) had recurrent rectovaginal fistula, and the mean number of prior attempts was 2.3 (0-8). The majority of patients (nine) had Crohn's disease-associated fistula, followed by six with iatrogenic fistula, two with radiation-induced fistula, two with obstetric injury-induced fistula, and two with idiopathic fistula. The mesh procedure was performed under faecal diversion in eight patients (38%). The mean operative time was 38 min; no intraoperative morbidity occurred. Patients were discharged from hospital on day 4. After a mean follow-up of 12 months (range, 3-18 months), the overall success rate after primary mesh procedure was 71% (15/21; 6 patients had failure or recurrence). All patients with failure or recurrence were reoperated upon. Out of these six patients who were reoperated upon, four had definite healing (75%). Among the eight patients who had faecal diversion, four (50%) had reversal of their stoma.
The preliminary success rate for this innovative technique using Surgisis mesh for the closure of rectovaginal fistulas is promising. Further studies are needed to assess the definite role of this novel technique in comparison to traditional surgical procedures.
这项前瞻性研究的目的是分析Surgisis网片用于闭合直肠阴道瘘的疗效。前瞻性数据收集自两个中心。
所有使用Surgisis网片进行确定性手术的直肠阴道瘘患者均被前瞻性纳入本研究。纳入标准包括直肠阴道隔下三分之二处的直肠阴道瘘。手术采用标准化技术进行，包括经直肠和经阴道联合切除直肠阴道瘘并经阴道放置网片。成功定义为内外开口（肛周和阴道）均闭合、无需进一步干预即无引流且无脓肿形成。
在16个月的时间里，两个中心共进行了21例网片手术。患者的平均年龄为47岁（18 - 59岁）。21例患者中，18例（86%）有复发性直肠阴道瘘，既往平均尝试次数为2.3次（0 - 8次）。大多数患者（9例）有克罗恩病相关瘘，其次是6例医源性瘘、2例放射性瘘、2例产科损伤性瘘和2例特发性瘘。8例患者（38%）在粪便转流情况下进行了网片手术。平均手术时间为38分钟；未发生术中并发症。患者于术后第4天出院。平均随访12个月（范围3 - 18个月）后，初次网片手术后的总体成功率为71%（15/21；6例患者失败或复发）。所有失败或复发的患者均再次手术。在这6例再次手术的患者中，4例（75%）实现了确切愈合。在8例进行粪便转流的患者中，4例（50%）造口得以回纳。
使用Surgisis网片闭合直肠阴道瘘的这项创新技术的初步成功率很有前景。需要进一步研究以评估这项新技术相对于传统手术方法的确切作用。
