Published online Apr 14, 2021. doi: 10.3748/wjg.v27.i14.1451
Peer-review started: January 4, 2021
First decision: January 23, 2021
Revised: January 29, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 14, 2021
Currently, rectovaginal fistula (RVF) continues to be a surgical challenge worldwide, with a relatively low healing rate. Unclosed intermittent suture and poor suture materials may be the main reasons for this.
To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.
This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included. Among the 82 total patients, 37 underwent repair with direct suturing and 45 underwent repair with stapling. Patient demographic data, Wexner faecal incontinence score, and operative data were analyzed. Recurrence rate and associated risk factors were assessed.
The direct suture and stapled repair groups showed similar clinical characteristics for aetiology, surgical history, fistula features, and perioperative Wexner score. The stapled repair group did not show superior results over the suture repair group in regard to operative time, blood loss, and hospital stay. However, the stapled repair group showed better postoperative Wexner score (1.04 ± 1.89 vs 2.73 ± 3.75, P = 0.021), less intercourse pain (1/45 vs 17/37, P = 0.045), and lower recurrence rate (6/45 vs 17/37, P = 0.001). There was no protective effect from previous repair history, smaller diameter of fistula (< 0.5 cm), better control of defecation (Wexner < 10), or stapled repair. Direct suture repair and preoperative high Wexner score (> 10) were risk factors for fistula recurrence. Furthermore, stapled repair gave better efficacy in treating complex RVFs (i.e., multiple transperineal repair history, mid-level fistula position, and poor control of defecation).
Stapled transperineal repair is advantageous for management of RVF, providing a high primary healing rate and low recurrence rate.
Core Tip: This retrospective cohort study evaluated efficacy and safety of the novel usage of stapling in repairing rectovaginal fistula (RVF). The overall recurrence risk of patients treated by staple repair was significantly lower than that of patients who underwent the conventional direct suture transperineal repair, especially for cases of complex RVFs, including multiple repair history, ≥ 10 preoperative Wexner score, or mid-level RVF status. According to the 5-year follow-up experience, stapled repair appears to be a promising surgical option for treating RVF, with high efficacy and safety.