The Disappointing Quality of Published Studies on Operative Techniques for Rectovaginal Fistulas

Abstract

No conclusion about the best surgical intervention for rectovaginal fistulas could be formulated. More large studies of high quality are needed to find the best treatment for rectovaginal fistulas. A design for these high-quality studies was formulated.

Rectovaginal Fistulas Secondary to Obstetrical Injury

“…In a recent systematic review, Göttgens et al were unable to recommend any specific repair technique due to small sample sizes, weak methodology, and high degrees of variation within the literature. 26 The literature largely consists of patient series in which different techniques are used for different groups of patients according to surgeon preference. 19,27,28 Smoking, 22 obesity, 23 and exposure to pelvic radiation 29 have been associated with significantly higher rates of recurrence.…”

Erste Ergebnisse der transperinealen Ligatur des Fisteltrakts bei rektovaginalen Fisteln

“…Alle chirurgischen Verfahren zum Verschluss einer rektovaginalen Fistel sind generell mit einer hohen Persistenz-und Rezidivrate assoziiert [2]. Zudem stehen infolge der Heterogenität der Studien (u. a. unterschiedliche Ätiologie der rektovaginalen Fistel, keine standardisierte Klassifikation, keine Differenzierung zwischen "hohen" und "tiefen" rektovaginalen Fisteln, verschiedene Operationstechniken, überwiegend retrospektives Studiendesign) und der fehlenden Qualitätsindikatoren kaum allgemeingültige Resultate und Schlussfolgerungen zur chirurgischen Verfahrenswahl bei der rektovaginalen Fistel zur Verfügung [12,13]. Generell scheinen die Ergebnisse hinsichtlich definitiver Fistelheilung nach Operation bei rektovaginalen Fisteln postpartaler Genese bzw.…”

Rectoperineal Fistula Repair Through Perineal Approach, Martius Flap, and House Advancement Flap

“…While nonsurgical management is appropriate for small and asymptomatic RPFs, for the majority of patients with significant symptoms, surgical management is the only definitive treatment [6]. There are a wide range of surgical interventions possible, including muscle transposition, laparoscopic technique, and rectal resection [2].…”

“…There are a wide range of surgical interventions possible, including muscle transposition, laparoscopic technique, and rectal resection [2]. However, given the low incidence and the lack of significant clinical studies, there is no consensus on the ideal surgical procedure to treat RPF [6]. For recurrent RPFs, due to the high probability for scarred and damaged tissue, the interposition of healthy tissue appears to be an appropriately indicated…”