Rectovaginal fistula in Crohn’s disease treatment: a low long-term success rate and a high definitive stoma risk after a conservative surgical approach

• Published in: Techniques in coloproctology 2021-10, Vol.25 (10), p.1143-1149
• Main Authors: Tracanelli, L., Mathieu, N., Trilling, B., Vergniol, J., Pigot, F., Faucheron, J.-L.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Colorectal Surgery; Fistula; Gastroenterology; Medicine; Medicine & Public Health; Original Article; Ostomy; Proctology; Remission (Medicine); Surgery
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-021-02506-8

Background Management of rectovaginal fistula (RVF) in Crohn’s disease (CD) is challenging. Available studies are heterogeneous and retrospective, with short-term follow-up. The aim of this study was to assess the overall long-term medico-surgical treatment results in women with RVF due to CD. Methods A retrospective study was conducted on consecutive patients operated on for RVF in CD from September 1996 to November 2019 at a tertiary teaching hospital. All surgeries were classified as preliminary, closure, or salvage procedures. Primary outcome was fistula remission defined as the combination of fistula closure and no stoma, at least 6 months since last procedure. Results Thirty-two patients (median age 34 [range 21–55] years), with a median follow-up of 11.3 years (0–23.7) after first surgery, were included. Altogether, 138 procedures were performed; 36 (26%) preliminary, 80 (58%) closure, and 13 (9%) salvage procedures. RVF remission was obtained in 7/32 patients (22%). At the end of follow-up, a stoma was present in 13/32 patients (41%). The percentage of time on biologics was 86% for patients in remission, versus 36% for the others ( p  = 0.0057). After univariate analysis, only anti-TNF-α was significantly related to successful closure techniques ( p  = 0.007). Conclusions The RVF remission rate in CD was low in the long term. However, patients underwent a succession of interventions, and the stoma rate was high. Combination of biologics with surgical management was crucial.