Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh

K.W. Gottgens, J. Heemskerk, W. van Gemert, R. Smeets, L.P. Stassen, G. Beets, C.G. Baeten, S.O. Breukink

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)

Abstract

BACKGROUND: A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures. METHODS: This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn's disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year. RESULTS: Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30-0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement. CONCLUSIONS: Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.
Original languageEnglish
Pages (from-to)817-823
Number of pages7
JournalTechniques in coloproctology
Volume18
Issue number9
DOIs
Publication statusPublished - Sep 2014

Keywords

  • Rectovaginal fistulas
  • Surgical treatment
  • Biomesh
  • Minimal invasive
  • Recurrence
  • QUALITY-OF-LIFE
  • ADVANCEMENT FLAP
  • SURGISIS(TM) MESH
  • CROHNS-DISEASE
  • DERMAL GRAFT
  • REPAIR
  • CLOSURE
  • RAT

Cite this

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title = "Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh",
abstract = "BACKGROUND: A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures. METHODS: This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn's disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year. RESULTS: Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 {\%} confidence interval 0.30-0.85). Three patients (25.0 {\%}) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 {\%}), the fistula failed to close within 3 months after the mesh placement. CONCLUSIONS: Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.",
keywords = "Rectovaginal fistulas, Surgical treatment, Biomesh, Minimal invasive, Recurrence, QUALITY-OF-LIFE, ADVANCEMENT FLAP, SURGISIS(TM) MESH, CROHNS-DISEASE, DERMAL GRAFT, REPAIR, CLOSURE, RAT",
author = "K.W. Gottgens and J. Heemskerk and {van Gemert}, W. and R. Smeets and L.P. Stassen and G. Beets and C.G. Baeten and S.O. Breukink",
year = "2014",
month = "9",
doi = "10.1007/s10151-014-1145-9",
language = "English",
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Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh. / Gottgens, K.W.; Heemskerk, J.; van Gemert, W.; Smeets, R.; Stassen, L.P.; Beets, G.; Baeten, C.G.; Breukink, S.O.

In: Techniques in coloproctology, Vol. 18, No. 9, 09.2014, p. 817-823.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh

AU - Gottgens, K.W.

AU - Heemskerk, J.

AU - van Gemert, W.

AU - Smeets, R.

AU - Stassen, L.P.

AU - Beets, G.

AU - Baeten, C.G.

AU - Breukink, S.O.

PY - 2014/9

Y1 - 2014/9

N2 - BACKGROUND: A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures. METHODS: This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn's disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year. RESULTS: Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30-0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement. CONCLUSIONS: Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.

AB - BACKGROUND: A rectovaginal fistula (RVF) is a debilitating condition that is difficult to treat. Many available techniques are invasive and involve extensive surgery. A local procedure with good closure rates would be preferable as a first step in the treatment of RVF. The aim of this study was the development of a local technique for the closure of RVF with good closure rates to prevent the use of more invasive procedures. METHODS: This was a pilot study. Patients with RVF who had undergone multiple operations in the pelvic area, local radiotherapy, chemotherapy or had been diagnosed with Crohn's disease were included in the study. All had a history of surgery for RVF. A cross-linked collagen matrix biomesh was placed in the rectovaginal septum using a transperineal or a transvaginal approach. The main outcome measure in this study was the closure rate reported as absence of the fistula at 1 year. RESULTS: Twelve patients were included in the study. Absence of fistula at 1 year was 0.64 (95 % confidence interval 0.30-0.85). Three patients (25.0 %) developed a recurrence, two were reoperated on with a gracilis flap transposition, and one was treated with laparoscopic ligation. In one patient (8.3 %), the fistula failed to close within 3 months after the mesh placement. CONCLUSIONS: Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed.

KW - Rectovaginal fistulas

KW - Surgical treatment

KW - Biomesh

KW - Minimal invasive

KW - Recurrence

KW - QUALITY-OF-LIFE

KW - ADVANCEMENT FLAP

KW - SURGISIS(TM) MESH

KW - CROHNS-DISEASE

KW - DERMAL GRAFT

KW - REPAIR

KW - CLOSURE

KW - RAT

U2 - 10.1007/s10151-014-1145-9

DO - 10.1007/s10151-014-1145-9

M3 - Article

VL - 18

SP - 817

EP - 823

JO - Techniques in coloproctology

JF - Techniques in coloproctology

SN - 1123-6337

IS - 9

ER -