Lava Christian X, Huffman Samuel S, Berger Lauren E, Marable Julian K, Spoer Daisy L, Fan Kenneth L, Lisle David M, Del Corral Gabriel A
Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Department Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Plast Surg (Oakv). 2025 Feb;33(1):149-158. doi: 10.1177/22925503231190923. Epub 2023 Aug 2.
Rectovaginal fistula (RVF) remains a complex complication following gender-affirming vaginoplasty. This review aims to evaluate RVF repair techniques and outcomes following vaginoplasty. A systematic review was performed per PRISMA guidelines. Ovid MEDLINE, Ovid EMBASE, Cochrane, and Web of Science were queried for records pertaining to RVF repair following vaginoplasty. Study characteristics, operative details, and demographics were collected. Outcomes included RVF repair method, recurrence rate, and complications. Among 282 screened citations, 17 articles representing 41 patients were included. Rectovaginal fistula repair methods identified included 4 conservative management approaches (n = 12 patients), primary closure with or without fistulectomy and ostomy (n = 22), 10 reconstructive surgical techniques (n = 18). The most common reconstructive techniques were V-Y full-thickness advancement with rectal flap (n = 5) and infragluteal fasciocutaneous flap (n = 4). Median time to recurrence was 6 months (interquartile range 7.5). Reported RVF repair complications included RVF recurrence (n = 5, 14.7%) and wound complication or dehiscence (n = 2, 5.88%). Three cases of RVF recurred after primary closure with or without fistulectomy and ostomy, while 2 cases of recurrence followed reconstruction. There remains a high level of variability in the approach to RVF repair following vaginoplasty. Reconstructive surgical techniques may be a more optimal solution without necessitating ostomies, but this decision must be considered in the context of RVF location, individual patient expectations, and clinical presentation.
直肠阴道瘘（RVF）仍然是性别确认阴道成形术后的一种复杂并发症。本综述旨在评估阴道成形术后RVF的修复技术和结果。按照PRISMA指南进行了系统综述。在Ovid MEDLINE、Ovid EMBASE、Cochrane和Web of Science数据库中查询了与阴道成形术后RVF修复相关的记录。收集了研究特征、手术细节和人口统计学数据。结果包括RVF修复方法、复发率和并发症。在282篇筛选出的文献中，纳入了17篇文章，共41例患者。确定的直肠阴道瘘修复方法包括4种保守治疗方法（12例患者）、有或无瘘管切除术及造口术的一期缝合（22例）、10种重建手术技术（18例）。最常见的重建技术是带直肠瓣的V-Y全层推进术（5例）和臀下筋膜皮瓣术（4例）。复发的中位时间为6个月（四分位间距7.5）。报告的RVF修复并发症包括RVF复发（5例，14.7%）和伤口并发症或裂开（2例，5.88%）。3例RVF在有或无瘘管切除术及造口术的一期缝合后复发，而2例复发发生在重建术后。阴道成形术后RVF修复方法的差异仍然很大。重建手术技术可能是一种更优的解决方案，无需进行造口术，但这一决定必须结合RVF的位置、患者个人期望和临床表现来考虑。
