Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2021; 27(14): 1451-1464
Published online Apr 14, 2021. doi: 10.3748/wjg.v27.i14.1451
Stapled transperineal repair for low- and mid-level rectovaginal fistulas: A 5-year experience and comparison with sutured repair
Qian Zhou, Zhi-Min Liu, Hua-Xian Chen, Dong-Lin Ren, Hong-Cheng Lin
Qian Zhou, Zhi-Min Liu, Hua-Xian Chen, Dong-Lin Ren, Hong-Cheng Lin, Department of Coloproctology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Qian Zhou, Zhi-Min Liu, Hua-Xian Chen, Dong-Lin Ren, Hong-Cheng Lin, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Qian Zhou, Zhi-Min Liu, Hua-Xian Chen, Dong-Lin Ren, Hong-Cheng Lin, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Zhou Q and Liu ZM drafted the manuscript and contributed equally to the study; Chen HX completed the statistical analysis; Lin HC and Ren DL served as the principal investigators, were responsible for the study plan, performed all of the surgical procedures, and finalized the manuscript; all authors have read and approved the final version of the manuscript.
Supported by The Sixth Affiliated Hospital, Sun Yat-sen University Clinical Research 1010 Program, No. 1010PY(2020)-18; Science and Technology Program of Guangzhou, China, No. 202002020081; National Natural Science Foundation of China, No. 81973847; and Natural Science Foundation of Guangdong Province of China, No. 2020A1515011254.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (No. E2018012).
Informed consent statement: Patients underwent sutured or stapled repair surgery after each agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare having no conflicts of interest related to this study or its publication.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Cheng Lin, FASCRS, MD, PhD, Doctor, Surgeon, Department of Coloproctology, The Sixth Affiliated Hospital of Sun Yat-sen University, No. 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. lhcheng@mail.sysu.edu.cn
Received: January 4, 2021
Peer-review started: January 4, 2021
First decision: January 23, 2021
Revised: January 29, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 14, 2021
Processing time: 94 Days and 20.4 Hours
Abstract
BACKGROUND

Currently, rectovaginal fistula (RVF) continues to be a surgical challenge worldwide, with a relatively low healing rate. Unclosed intermittent suture and poor suture materials may be the main reasons for this.

AIM

To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.

METHODS

This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included. Among the 82 total patients, 37 underwent repair with direct suturing and 45 underwent repair with stapling. Patient demographic data, Wexner faecal incontinence score, and operative data were analyzed. Recurrence rate and associated risk factors were assessed.

RESULTS

The direct suture and stapled repair groups showed similar clinical characteristics for aetiology, surgical history, fistula features, and perioperative Wexner score. The stapled repair group did not show superior results over the suture repair group in regard to operative time, blood loss, and hospital stay. However, the stapled repair group showed better postoperative Wexner score (1.04 ± 1.89 vs 2.73 ± 3.75, P = 0.021), less intercourse pain (1/45 vs 17/37, P = 0.045), and lower recurrence rate (6/45 vs 17/37, P = 0.001). There was no protective effect from previous repair history, smaller diameter of fistula (< 0.5 cm), better control of defecation (Wexner < 10), or stapled repair. Direct suture repair and preoperative high Wexner score (> 10) were risk factors for fistula recurrence. Furthermore, stapled repair gave better efficacy in treating complex RVFs (i.e., multiple transperineal repair history, mid-level fistula position, and poor control of defecation).

CONCLUSION

Stapled transperineal repair is advantageous for management of RVF, providing a high primary healing rate and low recurrence rate.

Keywords: Rectovaginal fistula; Surgical repair; Transperineal approach; Stapled technique; Recurrence

Core Tip: This retrospective cohort study evaluated efficacy and safety of the novel usage of stapling in repairing rectovaginal fistula (RVF). The overall recurrence risk of patients treated by staple repair was significantly lower than that of patients who underwent the conventional direct suture transperineal repair, especially for cases of complex RVFs, including multiple repair history, ≥ 10 preoperative Wexner score, or mid-level RVF status. According to the 5-year follow-up experience, stapled repair appears to be a promising surgical option for treating RVF, with high efficacy and safety.