Minimally invasive treatment of mid-low rectovaginal fistula: a transanal endoscopic surgery study

Abstract

Background

Treatment of rectovaginal fistulas (RVFs) is extremely difficult. No standard surgical procedure is accepted worldwide. The aim of this article was to evaluate a minimally invasive procedure for the repair of mid-low rectovaginal fistula.

Methods

This is a retrospective review of 17 patients who underwent minimally invasive surgery for the repair of mid-low rectovaginal fistulas (located in the lower or middle one-third of the vaginal wall) at our center between August 2016 and October 2018. The anal approach was adopted for 12 patients: 6 patients were treated directly by rectal mucosal advancement flap (RMAF) with transanal endoscopic surgery (TES), while the other 6 patients underwent initial TES exploration followed by RMAF procedure under direct vision. The vaginal approach was adopted for 5 patients: 3 patients were treated under TES directly and the other 2 were treated under direct vision after initial TES exploration. A total of 9 (52.94%) patients received diverting ileostomy—5 anal approach patients and 4 vaginal approach patients.

Results

Median age of the patients was 46 years (range 10–76 years), and median BMI was 21.9 (range 17.9–28.1). Median operative time was 75 min (range 60–120 min), and median duration of postoperative hospital stay was 8 days (range 6–15 days). Recurrence was seen in 3/12 anal approach patients vs. 0/5 vaginal approach patients. Both the median preoperative and the median postoperative Wexner score were 0 (range 0–2). The median follow-up time was 8 months (range 2–24). No severe complications occurred in any patient.

Conclusion

The TES procedure for the treatment of mid-low rectovaginal fistulas avoids any incision of the abdomen and perineal area and appears to be a safe and feasible procedure. This minimally invasive technique is still evolving and is likely to gain wide acceptance in the near future.

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Acknowledgements

We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Funding

This study was supported by Science and Technology Commission of Shanghai Municipality (Grant No. 201540382).

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Correspondence to Chunqiu Chen or Lu Yin.

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Xiaoqi Yuan, Hong Chen, Chunqiu Chen, Muqing Yang, Qiwei Li, Renyuan Gao, Xiaocai Wu, Weiwei Xu, Jing Sun, Lu Yin have no conflicts of interest or financial ties to disclose.

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Yuan, X., Chen, H., Chen, C. et al. Minimally invasive treatment of mid-low rectovaginal fistula: a transanal endoscopic surgery study. Surg Endosc 34, 3971–3977 (2020). https://doi.org/10.1007/s00464-019-07174-2

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Keywords

  • Rectovaginal fistula (RVF)
  • Transanal endoscopic surgery (TES)
  • Rectal mucosal advancement flap (RMAF)