Abstract:

Objective

To explore the difference and indication between various surgical treatment methods for rectovaginal fistula （RVF） that occurs after rectal tumor surgery.

Methods

Retrospectively collected clinical data of patients who developed RVF following rectal tumor surgery and were hospitalized for treatment in Peking Union Medical College Hospital from January 2014 to June 2022. The treatment plans，the outcomes of RVF healing were recorded.

Results

A total of 37 patients were included in the study，with an average age of （58 ± 13） years. Among them，twenty-eight had malignant tumors and 9 had benign tumors. Patients underwent 1，2，or 3 times of surgical treatments for RVF in 18 （48.6%），10 （27.0%），and 3 （8.1%） cases，respectively. Surgical methods included diversion surgery，transanal RVF repair，transanal combined with endoscopic RVF repair，transanal sphincteric RVF repair （Mason procedure），laparoscopic anterior rectal resection RVF repair （Dixon/Hartmann procedure），transvaginal repair，endoscopic RVF repair，and pelvic drainage surgery. Ultimately，seven patients’ （18.9%） RVF were cured and got stoma reversed，with a median reversal time of 37 months from the rectal surgery and 29 months from RVF discovery. Among the successfully reversed patients，five patients had benign tumors and 2 patients had malignant tumors，with a significant difference in reversal success rates between benign and malignant tumors （P=0.005）.

Conclusion

RVF following rectal tumor surgery causing lots of patients undergo multiple surgeries and are still unable to have their stomas reversed. Some patients face the risk of recurrent RVF even after stoma reversal. The success rate of treating complex RVF after malignant rectal tumor surgery is lower than that of benign tumors. The choice of RVF repair method should be based on the location，size，and complexity of the fistula. For fistulas located higher up，an abdominal approach is preferred. For cases where abdominal surgery is difficult or the fistula is located lower，transanal or perineal approach or a combined multi-approach repair is recommended. For patients with high-risk factors for RVF，prevention should be emphasized during the initial surgery.

Key words: Rectal neoplasms, Rectovaginal fistula, Surgical treatment