Kumar Ashok, Rauf Shahrukh, Aggarwal Manas, Sarangi Yajnadatta
Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.
Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Super Speciality Hospital, Lucknow, IND.
Cureus. 2025 Jun 19;17(6):e86400. doi: 10.7759/cureus.86400. eCollection 2025 Jun.
Background Rectovaginal fistulas (RVFs) are abnormal epithelial-lined tracts between the rectum and vagina that significantly impact quality of life. Their etiology is varied, and most cases require surgical repair. Multiple surgical approaches exist, with varying success rates ranging from very low to high. However, data from India on surgical outcomes remain limited. This study, conducted at a tertiary care center in North India, aims to evaluate the outcomes of RVF repair and identify factors associated with surgical success. Methodology This was a retrospective analysis of prospectively maintained data of all patients (n = 72) with RVF who were managed between 2005 and 2023 at a tertiary care hospital in North India. IBM SPSS Statistics software for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA) was used for statistical analyses. Continuous variables are presented as mean and standard deviation (SD) or median (interquartile range (IQR)), depending on normality status, while categorical variables are reported as raw values with percentages. Univariate analysis was performed using Pearson's chi-square and Fisher's exact tests. A p-value <0.05 was considered significant. Results A total of 72 patients were managed for RVF. Various etiological factors were iatrogenic injury in 23 (31.9%) patients, obstetric causes in 18 (25%) patients, malignancy in 19 (26%) patients, and congenital anomalies in five (7%) patients. Forty-eight (67%) patients required surgical intervention. Among those who underwent surgical intervention, various techniques were utilized: transvaginal layered closure in 24 (50%) patients, transvaginal advancement flap repair in 15 (31.3%) patients, transperineal layered closure with the Martius flap interposition in seven (14.6%) patients, and coloanal anastomosis in two (2.7%) patients. Fourteen (29%) patients required more than one surgical procedure. The overall success rate following surgical repair was 70.8%. No clinical or demographic factors were found to be statistically significant predictors of surgical failure. Conclusions In our study, the most common cause of RVF was iatrogenic injury. The majority of patients required surgical repair, with outcomes comparable to those reported in the literature. Among the various factors analyzed for their potential influence on surgical success, none were found to be significantly associated with the outcome.
背景 直肠阴道瘘（RVF）是直肠与阴道之间异常的上皮内衬通道，严重影响生活质量。其病因多样，大多数病例需要手术修复。存在多种手术方法，成功率从极低到高各不相同。然而，印度关于手术结果的数据仍然有限。本研究在印度北部的一家三级医疗中心进行，旨在评估RVF修复的结果并确定与手术成功相关的因素。
方法 这是一项对2005年至2023年期间在印度北部一家三级医疗医院接受治疗的所有RVF患者（n = 72）的前瞻性维护数据进行的回顾性分析。使用适用于Windows的IBM SPSS Statistics软件26.0版（IBM公司，美国纽约州阿蒙克）进行统计分析。连续变量根据正态性状态以均值和标准差（SD）或中位数（四分位间距（IQR））表示，而分类变量则以原始值及百分比报告。使用Pearson卡方检验和Fisher精确检验进行单因素分析。p值<0.05被认为具有统计学意义。
结果 共有72例患者接受了RVF治疗。各种病因包括医源性损伤23例（31.9%）、产科原因18例（25%）、恶性肿瘤19例（26%）、先天性异常5例（7%）。48例（67%）患者需要手术干预。在接受手术干预的患者中，采用了各种技术：经阴道分层缝合24例（50%）、经阴道推进皮瓣修复15例（31.3%）、经会阴分层缝合并置入Martius皮瓣7例（14.6%）、结肠肛管吻合术2例（2.7%）。14例（29%）患者需要不止一次手术。手术修复后的总体成功率为70.8%。未发现临床或人口统计学因素是手术失败的统计学显著预测因素。
结论 在我们的研究中，RVF最常见的原因是医源性损伤。大多数患者需要手术修复，其结果与文献报道的结果相当。在分析的对手术成功有潜在影响的各种因素中，没有发现任何因素与结果有显著关联。
