Martius flaps for low rectovaginal fistulae: a systematic review and proportional meta‐analysis

• Published in: ANZ journal of surgery 2024-09, Vol.94 (9), p.1471-1479
• Main Authors: Swindon, Daisy, Izwan, Sara, Ng, Justin, Chan, Erick, Abbas, Naveed, Von Papen, Michael, Sahebally, Shaheel Mohammad
• Format: Article
• Language: English
• Subjects: Adult; complication; Female; fistula; Fistulae; Humans; Meta-analysis; Population studies; primary; Radiation therapy; rectovaginal; Rectovaginal Fistula - surgery; Recurrence; Success; Surgical Flaps; Treatment Outcome
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.18922

Background Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various others, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition. Methods A PRISMA‐compliant meta‐analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, whilst secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta‐analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible. Results Twelve non‐randomized (11 retrospective, 1 prospective) studies, assessing 137 MF were included. The mean age of the study population was 42.4 (±15.7), years. There were 44 primary and 93 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45–98.46; I2 = 32.1%; P = 0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24–89.67; I2 = 58.1%; P = 0.008). The weighted mean complication rate was 29% (95% CI: 8.98–54.68; I2 = 85.4%; P