Functional outcome and quality of life evaluation of graciloplasty for the treatment of complex recto-vaginal and recto-urethral fistulas

Picciariello, Arcangelo; Papagni, Vincenzo; Fazio, Michele De; Martines, Gennaro; Méméo, Riccardo; Vitarelli, Antonio; Dibra, Rigers; Altomare, Donato F.

doi:10.1007/s13304-020-00704-x

Cited by 9 publications

(23 citation statements)

References 25 publications

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“…A small study of a Martius flap for low RVF revealed similar results [32]. A recent study by Picciariello et al showed a significant improvement in all but two of the SF-36 domains [33]. However, the study examined the results of both RVF and recto-urethral fistulation and included both men and women.…”

Section: Discussionmentioning

confidence: 83%

Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life

Söderqvist

Cashin

Graf

2022

Int J Colorectal Dis

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Purpose To determine the results after rectovaginal fistula (RVF) repair and find predictors of outcome. Primary objective was fistula healing. Secondary outcomes were morbidity and patient health-related quality of life (HRQoL). Method An observational study of 55 women who underwent RVF repair including both local procedures and tissue transposition 2003–2018 was performed. Baseline patient and fistula characteristics were registered, combined with a prospective HRQoL follow-up and a general questionnaire describing fistula symptoms. Results Healing rate after index surgery was 25.5% (n = 14) but the final healing rate was 67.3% (n = 37). Comparing the etiologies, traumatic fistulas (iatrogenic and obstetric) had the highest healing rates after index surgery (n = 11, 45.9%) and after repeated operations at final follow-up (n = 22, 91.7%) compared with fistulas of inflammatory fistulas (Crohn’s disease, cryptoglandular infection, and anastomotic leakage) that had inferior healing rates after both index surgery (n = 7, 7.1%) and at final follow-up (n = 13, 46.4%). Fistulas of the category others (radiation damage and unknown etiology) included a small amount of patients with intermediate results at both index surgery (n = 1, 33.3%) and healing rate at last follow-up (n = 2, 66.7%). The differences were statistically significant for both index surgery (p = 0.004) and at final follow-up (p = 0.001). Unhealed patients scored lower than both healed patients and the normal population in 6/8 Rand-36 domains, but the differences were not statistically significant. Conclusions Most traumatic rectovaginal fistulas closed after repeated surgery whereas inflammatory fistulas had a poor prognosis. Low healing rates after local repairs suggest that tissue transfer might be indicated more early in the treatment process. Unhealed fistulas were associated with reduced quality of life. Trial registration Clinicaltrials.gov No. NCT05006586.

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Section: Discussionmentioning

confidence: 83%

Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life

Söderqvist

Cashin

Graf

2022

Int J Colorectal Dis

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“…This is in definitive contrast with the epidemiological data on RVF, which report obstetric trauma as the cause of more than 90% of RVFs. 2 This could be because of the characteristics Kersting, 2019 21 Kharoub, 2021 22 Picciariello, 2020 29 Rottoli, 2018 34 Total events 8 1 6 Heterogeneity: χ 2 = 3.90, df = 4 (p = 0.42); I 2 = 0% Test for overall effect: Z = 1.18 (p = 0. of the reporting centers. In contrast, because RVFs caused by obstetric trauma often occur in otherwise healthy young patients, they may be more likely to heal with first-line treatments and less often need complex repairs.…”

Section: Discussionmentioning

confidence: 99%

“…The gracilis muscle was most commonly fixed to the contralateral ischial tuberosity, with several authors advising dissecting at least 2 to 3 cm above the fistula site. Picciariello et al 29 and Korsun et al 33 also wrapped the gracilis muscle around the anal canal in case of fecal incontinence.…”

Section: Operative and Postoperative Outcomesmentioning

confidence: 99%

“…Seven studies reported data on fecal incontinence. [21][22][23]25,29,30,32 Four used the Wexner score, 21,29,30,32 1 the Vaizey score, 1 the Park's and Corman's scores, 23 and 1 the Fecal Incontinence Quality of Life Score. 30 All studies reported improvement in postoperative scores after a successful repair.…”

Section: Fecal Incontinencementioning

confidence: 99%

“…Two studies performed anorectal manometry, 21,23 showing satisfactory results in patients after fistula closure. Kersting et al 21 Chen, 2013 32 Corte, 2015 39 Elliott, 2014 27 Frontali, 2021 28 Grott, 2021 30 Hull, 2021 31 Kersting, 2019 21 Kharoub, 2021 22 Korsun, 2019 33 Kulkami, 2016 23 Lefèvre, 2009 24 Nassar, 2011 25 Park, 2017 26 Picciariello, 2020 29 Rottoli, 2018 34 Ryoo, 2019 38 Troja, 2013 35 Ulrich, 2009 36 Yellinek, 2021 37 Overall Success rate (95% Cl) % Weight…”

Section: Fecal Incontinencementioning

confidence: 99%

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Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis

Maspero

Piñeiro

Steele

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, which is the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulas, but literature on the subject is scarce, mainly consisting of small case series. OBJECTIVE: This study aimed to assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula. DATA SOURCES: MEDLINE, Embase, Cochrane Library, and Web of Science. STUDY SELECTION: Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions was applied. INTERVENTION: Gracilis muscle interposition. MAIN OUTCOME MEASURES: The primary outcome is the fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, and sexual function. RESULTS: Twenty studies were included for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53%–74%; range, 33%–100%). Risk factors for failure were smoking, underlying Crohn’s disease, and more than 2 previous repairs, whereas stoma formation was associated with improved outcomes. Postoperative complications ranged from 0% to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, but impairment of sexual function was common. LIMITATIONS: Most of the included studies were small case series. CONCLUSIONS: Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent rectovaginal fistula. REGISTRATION NO.: CRD42022319621.

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What is the best surgical option after failure of graciloplasty in patients with recurrent rectovaginal fistula? A study of 19 consecutive patients

et al. 2022

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Functional outcome and quality of life evaluation of graciloplasty for the treatment of complex recto-vaginal and recto-urethral fistulas

Cited by 9 publications

References 25 publications

Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life

Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life

Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis

What is the best surgical option after failure of graciloplasty in patients with recurrent rectovaginal fistula? A study of 19 consecutive patients

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