Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1049
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
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.
To review the current applications and preliminary outcomes of this technique for RVF repair, aiming to give surgeons an alternative in clinical practice.
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.
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.
In conclusion, endoscopic repair of RVF is novel, minimally invasive and promising with acceptable preliminary effectiveness. Given its unique adva
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.