Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Dis Colon Rectum. 2023 May 1;66(5):631-645. doi: 10.1097/DCR.0000000000002739. Epub 2023 Feb 3.
A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, which is the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulas, but literature on the subject is scarce, mainly consisting of small case series.
This study aimed to assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula.
MEDLINE, Embase, Cochrane Library, and Web of Science.
Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions was applied.
Gracilis muscle interposition.
The primary outcome is the fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, and sexual function.
Twenty studies were included for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53%-74%; range, 33%-100%). Risk factors for failure were smoking, underlying Crohn's disease, and more than 2 previous repairs, whereas stoma formation was associated with improved outcomes. Postoperative complications ranged from 0% to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, but impairment of sexual function was common.
Most of the included studies were small case series.
Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent rectovaginal fistula.
CRD42022319621.
直肠阴道瘘是一种使人虚弱的疾病，常常严重影响生活质量。尽管有许多治疗选择，但最佳的手术治疗方法远未确定，许多患者在实现瘘管闭合之前将经历多次手术。将股薄肌转移到直肠阴道隔中是治疗复杂和持续性瘘管的一种选择，但该主题的文献很少，主要由小病例系列组成。
本研究旨在评估股薄肌间置术治疗直肠阴道瘘的成功率。
MEDLINE、Embase、Cochrane 图书馆和 Web of Science。
纳入至少有 5 例接受股薄肌间置术治疗直肠阴道瘘的患者的研究。没有对日期或语言进行限制。
股薄肌间置术。
主要结局是瘘管闭合率（%）。分析的其他领域包括造口关闭率、术后并发症、生活质量、粪便节制和性功能。
共纳入 20 项研究，总计 384 例患者。股薄肌间置术的瘘管闭合率为 64%（95%CI，53%-74%；范围，33%-100%）。失败的风险因素包括吸烟、潜在的克罗恩病和超过 2 次修复，而造口形成与更好的结果相关。术后并发症的范围从 0%到 37%不等，主要与手术部位在采集部位和会阴区域的发生有关。没有死亡发生。股薄肌间置术改善了生活质量和粪便节制，但性功能障碍很常见。
大多数纳入的研究都是小病例系列。
股薄肌间置术是一种安全且中度有效的治疗方法，可作为复发性直肠阴道瘘的二线或三线治疗方法。
CRD42022319621。
