Surgical management of complicated rectovaginal fistulas and the role of omentoplasty

Schloericke, Erik; Zimmermann, Markus; Benecke, Claudia; Laubert, Tilman; Meyer, Rüdiger; Bruch, Hans–Peter; Bouchard, R.; Keck, Tobias; Hoffmann, Martin

doi:10.1007/s10151-017-1657-1

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…Application of omentoplasty is a well-established option for filling of a presacral cavity after both primary abdominoperineal resection [1] and more complex salvage surgery [2–5]. Success of an omentoplasty depends on the adequacy of filling the pelvic cavity, determined by the omental volume and length.…”

Section: Introductionmentioning

confidence: 99%

Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

et al. 2019

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BackgroundDuring creation of a pedicled omentoplasty, blood flow to segments of the omentum might become compromised. If unrecognized, this can lead to omental necrosis. The purpose of this study was to investigate the potential added intra-operative value of the use of fluorescence angiography (FA) with indocyanine green (ICG) to assess omental perfusion.MethodsAll consecutive patients undergoing a pedicled omentoplasty in a 6-month period (April 1 2018–October 1 2018) in a University hospital were included. The primary outcome was change in management due to FA. Secondary outcomes included the amount of additionally resected omentum, added surgical time, and quantitative fluorescent values (time to fluorescent enhancement, contrast quantification).ResultsFifteen patients had pelvic surgery with omentoplasty and FA. Change in management occurred in 12 patients (80%) and consisted of resecting a median of 44 g (range 12–198 g) of poorly perfused omental areas that were not visible by conventional white light. The median added surgical time for the use of FA and subsequent management was 8 min (range 3–39 min). The first fluorescent signal in the omental tissue appeared after a median of 20 s (range 9–37 s) after injection of ICG. The median signal-to-baseline ratio was 23.7 (interquartile range 12.2–29.7) in well perfused and 2.5 (interquartile range 1.7–4.0) in poorly perfused tissue.ConclusionsFA of a pedicled omentoplasty allows a real-time assessment of omental perfusion and leads to change in management in 80% of the cases in this pilot study. These findings support the conduct of larger studies to determine the impact on patient outcome in this setting.

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Section: Introductionmentioning

confidence: 99%

Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

et al. 2019

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“…A total of 16 studies were included in the qualitative synthesis for RVF and AVF: 14 addressing RVF only, 1 addressing AVF only, and 1 addressing both RVF and AVF (combined) (Table 1). Most studies (n = 14) were retrospective cohort studies or case series that met the review de nition for cohort studies [9,14,15,10,[16][17][18][19][20][21][22][23][24][25]. The SLR also included one retrospective, unmatched case-control study [26] and one prospective cohort/registry study [27].…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

“…'Recurrence rates' were speci cally reported in two studies and ranged from 13.3% (complicated recurrence due to development of multiple perianal stulas with severe sepsis) to 55.8% across multiple procedures [22,24]. Five studies reported post-operative infection rates; however, two [16,22] did not report rates by stula type.…”

Section: Treatment Patternsmentioning

confidence: 99%

“…Five studies reported post-operative infection rates; however, two [16,22] did not report rates by stula type. In the three studies that did report RVF/AVF-speci c rates, 1-13.3% of patients experienced a post-operative infection, including one abscess [17], one urinary tract infection [19], and two cases of severe sepsis [24]. Further complicating interpretation of these results is the variance in median or mean follow-up duration which ranged from 13 months [24] to 7 years [16].…”

Section: Treatment Patternsmentioning

confidence: 99%

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A Systematic Review of the Patient Burden of Crohn’s Disease-related Rectovaginal and Anovaginal Fistulas

Iglay¹,

Bennett²,

Kappelman³

et al. 2021

Preprint

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BackgroundCrohn’s disease (CD)-related rectovaginal fistulas (RVFs) and anovaginal fistulas (AVFs) are rare, debilitating conditions that present a substantial disease and treatment burden for women. This systematic literature review (SLR) assessed the burden of Crohn’s-related RVF and AVF, summarizing evidence from observational studies and highlighting knowledge gaps.MethodsThis SLR identified articles in PubMed and Embase that provide data and insight into the patient experience and disease burden of Crohn’s-related RVF and AVF. Two trained reviewers used pre-specified eligibility criteria to identify studies for inclusion and evaluate risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for observational studies.ResultsOf the 582 records identified, 316 full-text articles were assessed, and 16 studies met a priori eligibility criteria and were included. Few epidemiology studies were identified, with one study estimating the prevalence of RVF to be 2.3% in females with Crohn’s disease. Seven of 12 treatment pattern studies reported that patients had or required additional procedures before and/or after the intervention of interest, demonstrating a substantial treatment burden. Seven of 11 studies assessing clinical outcomes reported fistula healing rates between 50% and 75%, with varying estimates based on population and intervention.ConclusionsThis SLR reports the high disease and treatment burden of Crohn’s-related RVF and AVF and identifies multiple evidence gaps in this field. The literature lacks robust, generalizable data, and demonstrates a compelling need for substantial, novel research into these rare and debilitating sequelae of CD.RegistrationThe PROSPERO registration number for the protocol for this systematic literature review is CRD42020177732.

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“…Dear Sir, I read with interest the article by E. Schloericke et al [1], entitled "Surgical management of complicated rectovaginal fistulas and the role of omentoplasty" published in Techniques in Coloproctology, in which the authors reported their treatment of rectovaginal fistulas in 58 patients, 19 of whom had a history of cancer with a primary localization in the pelvis. There are important considerations to make before transposing the omentum to the pelvis in patients with cancer.…”

mentioning

confidence: 99%

Is it correct to perform omentoplasty to repair rectovaginal fistulas in oncological patients?

Macrì

2018

Tech Coloproctol

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Surgical management of complicated rectovaginal fistulas and the role of omentoplasty

Abstract: Non-resecting methods should be used only in uncomplicated fistulas. Rectovaginal fistulas secondary to inflammatory or malignant disease mostly require extensive therapy. Omentoplasty is effective for the treatment of both high and low rectovaginal fistulas.

Cited by 17 publications

References 34 publications

Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

A Systematic Review of the Patient Burden of Crohn’s Disease-related Rectovaginal and Anovaginal Fistulas

Is it correct to perform omentoplasty to repair rectovaginal fistulas in oncological patients?

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