Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 1049-1059
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1049
Minimally invasive endoscopic repair of rectovaginal fistula
Yi-Xian Zeng, Ying-Hua He, Yun Jiang, Fei Jia, Zi-Ting Zhao, Xiao-Feng Wang
Yi-Xian Zeng, Ying-Hua He, Yun Jiang, Fei Jia, Zi-Ting Zhao, Xiao-Feng Wang, Department of Proctology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Author contributions: All authors contributed to this manuscript; Zeng YX, Wang XF and He YH designed the outline of this review; Zeng YX performed most of the writing, and prepared the figures and tables; Wang XF and He YH made critical revision of the manuscript for important intellectual content; Jiang Y, Jia F and Zhao ZT performed data acquisition, and writing; All authors read and approved the final version.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Feng Wang, MD, Doctor, Surgeon, Department of Proctology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 North Line Pavilion, Xicheng District, Beijing 100053, China. wangxiaofeng74@hotmail.com
Received: May 28, 2022
Peer-review started: May 28, 2022
First decision: June 19, 2022
Revised: June 30, 2022
Accepted: September 2, 2022
Article in press: September 2, 2022
Published online: September 27, 2022
Processing time: 117 Days and 0.8 Hours
Abstract
BACKGROUND

Surgical techniques for repair of rectovaginal fistula (RVF) have been continually developed, but the ideal procedure remains unclear. Endoscopic repair is a novel and minimally invasive technique for RVF repair with increasing reporting.

AIM

To review the current applications and preliminary outcomes of this technique for RVF repair, aiming to give surgeons an alternative in clinical practice.

METHODS

Available articles were searched according to the search strategy. And the sample size, fistula etiology, fistula type, endoscopic repair approaches, operative time and hospital stay, follow-up period, complication and life quality assessment were selected for recording and further analysis.

RESULTS

A total of 11 articles were eventually identified, involving 71 patients with RVFs who had undergone endoscopic repair. The principal causes of RVFs were surgery (n = 51, 71.8%), followed by obstetrics (n = 7, 9.8%), inflammatory bowel disease (n = 5, 7.0%), congenital (n = 3, 4.2%), trauma (n = 2, 2.8%), radiation (n = 1, 1.4%), and in two patients, the cause was unclear. Most fistulas were in a mid or low position. Several endoscopic repair methods were included, namely transanal endoscopic microsurgery, endoscopic clipping, and endoscopic stenting. Most patients underwent > 1-year follow-up, and the success rate was 40%-93%, and all cases reported successful closure. Few complications were mentioned, while postoperative quality of life assessment was only mentioned in one study.

CONCLUSION

In conclusion, endoscopic repair of RVF is novel, minimally invasive and promising with acceptable preliminary effectiveness. Given its unique advantages, endoscopic repair can be an alternative technique for surgeons.

Keywords: Endoscopic repair; Minimal-invasive technique; Rectovaginal fistula

Core Tip: The current status of minimally invasive endoscopic repair for rectovaginal fistulas (RVFs) was reviewed. This is the first review to explore the current application status and evaluate the preliminary outcomes. Endoscopic repair is recommended as a novel and promising technique for RVF and warrants consideration by surgeons. The disappointing quality of published studies on surgical treatment of RVF is discussed, along with the possible role of endoscopic repair in improving the situation.