Post surgical rectovaginal fistula: who really benefits from stoma diversion?

To analyze the role of stoma diversion and timing of stoma maintenance in the healing of post-surgical Recto Vaginal Fistulae (psRVF). A retrospective analysis of a prospectively maintained registry. All patients with a psRVF diagnosed at IRCCS Sacro Cuore—Don Calabria Hospital of Negrar di Valpolicella from January 2002 to December 2016 were analyzed. The baseline treatment was a fecal diversion. Patients were divided into two groups according to healing time: 6 months (Group 2). 2043 women underwent rectal resections in the study period. We recorded 37 patients with psRVF (1.8%). Nineteen women (51.3%) healed (Group 1) within 6 months. The median time of psRVF recovery in group 1 was 99.7 days. Concomitant local treatment of the fistula did not influence the healing rate (p 0.8). Colostomies were significantly higher in group 1 (p 0.003). The size of the psRVF influenced the success rate of fistula healing with loop stoma (p 0.07). A multivariate analysis the presence of fever and pelvic abscess (pelvis sepsis) were significantly associated with diversion failure (p 0.035). A step-up approach with the maintenance of loop stoma at least for six months for all patients with psRVF could be changed. Patients with larger fistula and pelvic sepsis at index procedure should be addressed earlier to a specific second-level treatment. Similar content being viewed by others

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For English language revision thanks to Alex M Almoudaris. Funding This research received no grant from any funding agency in the public, commercial or not-for-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest All authors declare that they have no conflict of interest and nothing to disclose. Research involving human participants and/or animals The ethics committee approved this study. Informed consent All patients signed a written acceptance to be included in this study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Barugola, G., Bertocchi, E., Leonardi, A. et al. Post surgical rectovaginal fistula: who really benefits from stoma diversion?. Updates Surg 73, 165–171 (2021). https://doi.org/10.1007/s13304-020-00810-w Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13304-020-00810-w