Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Dis Colon Rectum. 2014 Jul;57(7):888-98. doi: 10.1097/DCR.0000000000000147.
Treatment of rectovaginal fistulas is difficult, and many surgical interventions have been developed. The best surgical intervention for the closure of these fistulas is still unclear.
A systematic review was performed reporting the outcomes of different surgical techniques for rectovaginal fistulas.
Medline (PubMed, Ovid), Embase (Ovid), and The Cochrane Library databases were searched for eligible articles as well as the references of these articles.
Two independent reviewers analyzed the search results for eligible articles based on title, abstract, and described results.
INTERVENTION(S): Any surgical intervention for the closure of rectovaginal fistulas was included.
The main outcome was closure rate. Secondary outcomes were quality of life, morbidity, and the effect on sexual functioning.
Many articles with different operative techniques were identified and classified in the following categories: advancement flaps (endorectal and endovaginal), transperineal closure, Martius procedure, gracilis muscle transposition, rectal resections, transabdominal closure, mesh repair, plugs, endoscopic repairs, closure with biomaterials, and miscellaneous techniques. Results vary widely with closure rates between 0% and >80%. None of the studies were randomized. Because of the poor quality of the identified studies, the comparison of results and performance of a meta-analysis were not possible.Data regarding the secondary outcomes were mostly unavailable.
The major limitation of this review was the limited availability of high-quality prospective studies, making it impossible to perform a meta-analysis.
No conclusion about the best surgical intervention for rectovaginal fistulas could be formulated. More large studies of high quality are needed to find the best treatment for rectovaginal fistulas. A design for these high-quality studies was formulated.
直肠阴道瘘的治疗较为困难，已开发出许多手术干预措施。但对于这些瘘管，哪种手术干预效果最好仍不清楚。
本系统评价旨在报告不同手术技术治疗直肠阴道瘘的结局。
对 Medline（PubMed、Ovid）、Embase（Ovid）和 Cochrane 图书馆数据库进行检索，查找符合条件的文章及其参考文献。
两名独立的审查员根据标题、摘要和描述的结果对符合条件的文章进行分析。
任何用于闭合直肠阴道瘘的手术干预措施均纳入。
主要结局为闭合率。次要结局为生活质量、发病率和对性功能的影响。
确定了许多采用不同手术技术的文章，并将其分类为：内进路皮瓣（直肠内和阴道内）、经会阴闭合、Martius 手术、股薄肌移位、直肠切除术、经腹闭合、网状修复、填塞物、内镜修复、生物材料闭合和其他技术。结果差异很大，闭合率在 0%到>80%之间。没有研究是随机的。由于所确定研究的质量较差，无法进行结果比较和荟萃分析。关于次要结局的数据大多不可用。
本综述的主要局限性是高质量前瞻性研究的缺乏，使得无法进行荟萃分析。
无法确定直肠阴道瘘的最佳手术干预措施。需要更多高质量的大型研究来找到直肠阴道瘘的最佳治疗方法。为此制定了这些高质量研究的设计。
