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Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistula: is Crohn’s disease a risk factor for failure? A prospective cohort study

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Abstract

Background

The surgical management of rectovaginal fistulae associated with Crohn’s disease is often frustrated by poor results regardless of the different techniques. The outcomes of the gracilis muscle transposition (GMT) for the treatment of recurrent Crohn’s-associated fistulae are still debated. The aim of the study is to determine whether the success rate of GMT is similar in Crohn’s disease patients and in a control group.

Materials and methods

All patients undergoing GMT for rectovaginal or pouch-vaginal fistula were collected from a prospectively maintained database (2005–2016). The primary study outcome was the comparison of the success rate of GMT in Crohn’s disease and control group patients.

Results

Twenty-one patients with a rectovaginal fistula due to Crohn’s disease (8, 38.1%) or other etiologies (13, 61.9%) were included. The groups had similar characteristics and postoperative outcomes. After a median follow-up time of 81 and 57 months (p 0.34), the success rate of GMT was 75% in patients with Crohn’s disease and 68.4% in control group (p 0.6). The median time to recurrence was 3.5 months (1–12). The success rate in patients who had more than two previous attempts of repair was lower regardless of the etiology (50 vs 79.4%, p 0.1).

Conclusion

GMT is associated with a high success rate, especially in Crohn’s disease-related rectovaginal fistula. In consideration of the low morbidity rate and the fact that an increasing number of previous local operations might be associated with failure, the procedure should be considered as a first line of treatment for recurrent rectovaginal fistulae.

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Authors and Affiliations

  1. Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant’Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Matteo Rottoli, Carlo Vallicelli, Luca Boschi & Gilberto Poggioli

  2. Plastic Surgery, Sant’Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Riccardo Cipriani

Authors
  1. Matteo Rottoli
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  2. Carlo Vallicelli
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  3. Luca Boschi
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  4. Riccardo Cipriani
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  5. Gilberto Poggioli
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Corresponding author

Correspondence to Matteo Rottoli.

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None.

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The ethics committee and review board in our institute approved the study and treatment protocol.

Informed consent

Informed consent was obtained from all patients who agreed to participate in the study.

Additional information

A part of the present study was accepted as a poster presentation at the ESCP (European Society of Coloproctology) 11th Scientific and Annual Meeting 2016, Milan, Italy, 28–30th September.

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Rottoli, M., Vallicelli, C., Boschi, L. et al. Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistula: is Crohn’s disease a risk factor for failure? A prospective cohort study. Updates Surg 70, 485–490 (2018). https://doi.org/10.1007/s13304-018-0558-9

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  • DOI: https://doi.org/10.1007/s13304-018-0558-9

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