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• W2594906242 abstract "Rectovaginal fistula (RVF) may occur as complication of malignancy, obstetric trauma, radiation, inflammatory bowel disease, infection and/or surgery. Flaps may be used in fistula repair to aid healing in complex cases refractory to standard techniques. The purpose of this study was to investigate outcomes of flap reconstruction of RVF. All patients who underwent flap reconstruction of any type of fistula at Mayo Clinic between January 1995 and December 2014 were identified using electronic medical records for this retrospective cohort study. All men were excluded. Women undergoing RVF repair using flap reconstruction were then identified and baseline demographics including surgical indications were obtained. Surgical outcomes and complications were collected by chart review. Operative success was defined as absence of fistula recurrence within six months of surgery. A total of 59 patients were identified as having undergone flap reconstructions for management of a fistula. Of these, 42 (71.2%) were women and, specifically 31 had a flap used in the treatment of a rectovaginal fistula. Rectovaginal fistula etiologies included 10 (32.3%) with malignancy, 7 (22.6%) with Crohn’s disease or ulcerative colitis, 6 (19.4%) with obstetric complications, 3 (9.7%) with diverticulitis or infection, and 5 (16.1%) other. There were 35 flap reconstructions performed on this cohort of 31 women. A total of 20 (57.1%) had prior fistula repair attempt before flap reconstruction. Of the 35 flaps used, 13 (37.2%) were Martius, 11 (31.4%) were gracilis, and 11 (31.4%) were other (omental, psoas, mucosal, and rectus abdominis). Overall, 19 (54.3%) had successful repair, while 16 (45.7%) experienced recurrent fistula. Of the 10 who had preoperative radiation, 7 (70%) had successful repair. Of the 10 who had malignancy, 7 (70%) had successful repair. Of the 7 who had inflammatory bowel disease, 5 (71.4%) had successful repair. Three (50.0%) of the 6 patients who had obstetric etiology had successful repair; however one of these patients experienced a flap failure followed by flap repair success resulting in an overall success rate of 42.9% in patients with obstetric etiology. All patients with obstetric etiology had experienced at least one failed repair prior to flap placement. Flap use in repair of RVF is a viable option, particularly in complex cases. Approximately 70% of patients who had preoperative radiation, malignancy, or bowel disease had successful flap reconstruction of RVF. Flap reconstruction was less successful in women with a complicated fistula of obstetric etiology." @default.
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• W2594906242 date "2017-03-01" @default.
• W2594906242 modified "2023-09-27" @default.
• W2594906242 title "22: Flap use in repair of rectovaginal fistula" @default.
• W2594906242 doi "https://doi.org/10.1016/j.ajog.2016.12.146" @default.
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