Paluku Justin Lussy, Sikakulya Franck Katembo, Furaha Cathy Mufungizi, Kamabu Eugénie Mukekulu, Mukuku Olivier, Tsongo Zacharie Kibendelwa, Wembonyama Stanis Okitotsho, Mpoy Charles Wembonyama, Juakali Jeannot Sihalikyolo
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
Reprod Health. 2025 Mar 12;22(1):37. doi: 10.1186/s12978-025-01971-w.
Rectovaginal fistula (RVF) is a complex debilitating condition that results from several etiologies, obstetric trauma being the most common. Occasionally RVF closure is non-successful. The objective of this study is to develop a predictive score to identify predictors of failure of surgical closure of obstetric RVF (FSCORVF) in the Democratic Republic of the Congo.
This was an analytical cross-sectional study conducted on 268 patients with obstetric RVF who have received surgical management. We proceeded with a bivariate and then multivariate analysis. Score discrimination was assessed using the ROC curve and C-index and score calibration was done according to the Hosmer-Lemeshow test.
Surgical closure of RVF failed in 12.31% of cases (33/268). After logistic modelling, five criteria emerged as predictive factors of FSCORVF (LUSSY Score): the presence of moderate/severe fibrosis (aOR: 36.25; 95% CI: 1.88-699.37), combined RVF with other type of fistula (aOR: 61.41; 95% CI: 8.78-429.72), fistula size > 3 cm (aOR: 82.45; 95% CI: 10.48-648.58), per-operative hemorrhage (aOR: 27.84;; 95% CI: 5.08-152.47) and postoperative infection (aOR: 1161.35; 95% CI: 46.89-28765.47). A score of 0 to 22 was obtained with a value ≤ 9 points indicating a low risk of FSCORVF, a value between 10 and 12 defining a moderate risk and the value ≥ 13 points corresponding to a high risk of FSCORVF. The area under the ROC curve of the score is 0.9744 with a sensitivity of 90.91%, a specificity of 97.87%, a positive predictive value of 85.71% and a negative predictive value of 98.71%.
This study identified predictive factors for FSCORVF in the DRC, grouped in the LUSSY score. Complex fistulas (fistula size > 3 cm, severe fibrosis, combined fistulas) require advanced surgical routes different from the transvaginal and the transperineal ones used in the present study. Prevention of intraoperative hemorrhage and postoperative infections requires rigorous preparation, appropriate antibiotic prophylaxis, and strict postoperative follow-up.
直肠阴道瘘（RVF）是一种复杂的使人衰弱的病症，由多种病因引起，其中产科创伤最为常见。偶尔，RVF闭合手术会不成功。本研究的目的是制定一个预测评分，以识别刚果民主共和国产科RVF手术闭合失败（FSCORVF）的预测因素。
这是一项对268例接受手术治疗的产科RVF患者进行的分析性横断面研究。我们先进行了双变量分析，然后进行多变量分析。使用ROC曲线和C指数评估评分的区分度，并根据Hosmer-Lemeshow检验进行评分校准。
12.31%的病例（33/268）RVF手术闭合失败。经过逻辑建模，五个标准成为FSCORVF的预测因素（LUSSY评分）：存在中度/重度纤维化（调整后比值比：36.25；95%置信区间：1.88-699.37）、合并RVF与其他类型瘘管（调整后比值比：61.41；95%置信区间：8.78-429.72）、瘘管大小>3 cm（调整后比值比：82.45；95%置信区间：10.48-648.58）、术中出血（调整后比值比：27.84；95%置信区间：5.08-152.47）和术后感染（调整后比值比：1161.35；95%置信区间：46.89-28765.47）。获得的评分为0至22分，≤9分表示FSCORVF风险低，10至12分定义为中度风险，≥13分对应FSCORVF高风险。该评分的ROC曲线下面积为0.9744，灵敏度为90.91%，特异度为97.87%，阳性预测值为85.71%，阴性预测值为98.71%。
本研究确定了刚果民主共和国FSCORVF的预测因素，并将其纳入LUSSY评分。复杂瘘管（瘘管大小>3 cm、严重纤维化、合并瘘管）需要与本研究中使用的经阴道和经会阴手术途径不同的先进手术途径。预防术中出血和术后感染需要严格的准备、适当的抗生素预防和严格的术后随访。
