Karp Natalie E, Kobernik Emily K, Berger Mitchell B, Low Chelsea M, Fenner Dee E
From the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Female Pelvic Med Reconstr Surg. 2019 Jan/Feb;25(1):36-40. doi: 10.1097/SPV.0000000000000484.
Rectovaginal fistulas can occur from both obstetric and nonobstetric (eg, inflammatory bowel disease, iatrogenic, or traumatic) etiologies. Current data on factors contributing to rectovaginal repair success or failure are limited, making adequate patient counseling difficult. Our objective was to compare outcomes of transperineal rectovaginal fistula repair performed in a single referral center on women with obstetric and nonobstetric causes.
We performed a retrospective cohort study of women who had a transperineal rectovaginal fistula repair performed by a urogynecologist at the University of Michigan from 2005 to 2015. Data were obtained by chart review and included demographics, medical comorbidities, fistula etiology, history of a prior fistula repair, failure of current repair, time to failure, and operative details. Repair failure was defined as fistula symptoms with presence of recurrent fistula on exam or imaging in the postoperative follow-up period. Comparisons between the obstetric and nonobstetric cohorts were performed using χ, Fisher exact, and Wilcoxon rank sum tests. Relative risks were calculated to identify predictors of failure.
Eighty-eight women were included-53 obstetric and 35 nonobstetric fistulas. The overall fistula repair failure rate was 22.7% (n = 20). Median follow-up was 157.0 days (range, 47.5-402.0). Of all the factors, only nonobstetric etiology was significantly associated with an increased risk of repair failure (relative risk, 3.53 [range, 1.50-8.32]; P = 0.004.
Nonobstetric rectovaginal fistulas have a nearly 4-fold increased risk of repair failure compared with obstetric fistulas. Our results will help surgeons adequately counsel patients on potential outcomes of surgical repair of obstetric versus nonobstetric rectovaginal fistulas.
直肠阴道瘘可由产科病因和非产科病因（如炎症性肠病、医源性或创伤性）引起。目前关于影响直肠阴道瘘修复成功或失败因素的数据有限，这使得对患者进行充分的咨询变得困难。我们的目的是比较在单一转诊中心对因产科和非产科原因导致直肠阴道瘘的女性进行经会阴直肠阴道瘘修复的结果。
我们对2005年至2015年在密歇根大学由一名泌尿妇科医生进行经会阴直肠阴道瘘修复的女性进行了一项回顾性队列研究。通过查阅病历获取数据，包括人口统计学资料、内科合并症、瘘管病因、既往瘘管修复史、本次修复失败情况、失败时间以及手术细节。修复失败定义为在术后随访期间检查或影像学检查发现存在复发性瘘管且伴有瘘管症状。使用χ检验、Fisher精确检验和Wilcoxon秩和检验对产科和非产科队列进行比较。计算相对风险以确定失败的预测因素。
共纳入88名女性，其中53例为产科瘘管，35例为非产科瘘管。总体瘘管修复失败率为22.7%（n = 20）。中位随访时间为157.0天（范围47.5 - 402.0天）。在所有因素中，只有非产科病因与修复失败风险增加显著相关（相对风险为3.53 [范围1.50 - 8.32]；P = 0.004）。
与产科直肠阴道瘘相比，非产科直肠阴道瘘修复失败的风险增加近4倍。我们的结果将有助于外科医生就产科与非产科直肠阴道瘘手术修复的潜在结果对患者进行充分咨询。
