A 20-year Experience of Rectovaginal Fistula Management in a Tertiary University Hospital in Thailand
Varut Lohsiriwat MD, PhD*, Danupon Arsapanom MD*, Siriluck Prapasrivorakul MD*, Cherdsak Iramaneerat MD*, Woramin Riansuwan MD*, Wiroon Boonnuch MD*, Darin Lohsiriwat MD*
Affiliation : * Colorectal Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The purpose of this study was to determine etiology, treatment and outcome of patients with rectovaginal fistula
(RVF) who were treated in a tertiary university hospital in Thailand.
Material and Method: The authors retrospectively reviewed the medical records of patients with RVF treating from 1994 to
2013 at the Faculty of Medicine Siriraj Hospital. Data were recorded including patient’s demographics, etiology, treatment
and outcome.
Results : This study included 108 patients with median age of 55 years (range 24 to 81). Radiation injury was the most common
cause of RVF (44%) followed by direct invasion of rectal or gynecologic malignancies (20%), postoperative complication
(16%) (notably from 10 low anterior resections, 5 transabdominal hysterectomies, 1 stapled hemorrhoidopexy and 1
injection sclerotherapy for hemorrhoid) and obstetric injury (11%). Diverting colostomy was the most frequent operation
performed for both radiation-related RVF and malignancy-related RVF. Most operation-related RVF were healed after fecal
diversion with or without either local repair or major resection. All obstetric-related RVFs were successfully treated by local
tissue repair with or without anal sphincteroplasty.
Conclusion : Radiation injury and advanced pelvic malignancies were two most common causes of RVF in this study. Fecal
diversion can be either initial operation or definite treatment in most patients with RVF. Surgical correction resulted in good
outcomes for postoperative RVF and obstetric-related RVF.
Keywords : Rectovaginal fistula, Rectum, Vagina, Fistula, Surgery, Complication, Radiation, Obstetric, Management, Outcome
