Predictors of outcome for treatment of enterovaginal fistula,International Journal of Colorectal Disease

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Predictors of outcome for treatment of enterovaginal fistula
International Journal of Colorectal Disease ( IF 2.5 ) Pub Date : 2023-07-07 , DOI: 10.1007/s00384-023-04453-2
Moritz Drefs ₁ , Sebastian Schömer Cuenca ₂ , Ulrich Wirth ₁ , Florian Kühn ₁ , Maria Burian ₁ , Jens Werner ₁ , Petra Zimmermann ₁

Affiliation

Background

Enterovaginal fistulas represent a serious complication of various diseases and therapeutic procedures, often associated with complicated clinical courses and massive impairment of quality of life. As underlying conditions and procedures are multifarious, therapeutic approaches are challenging and have to be tailored individually. As the therapeutic management is complex and individualized, multiple surgical interventions might be necessary.

Methods

The aim of this study was to identify possible predictors for outcome in the treatment enterovaginal fistula patients. The study was realized as a retrospective analysis. Ninety-two patients treated with enterovaginal fistulas between 2004 and 2016 were analyzed. Patient characteristics, therapeutic data, and endoscopic findings were stratified according to etiology, closure rate and time, as well as recurrence of fistula. Main outcome measure was the overall rate of fistula closure.

Results

Overall therapeutic success rate was 67.4%. Postoperatively derived fistulas were most frequent (40.2%), mainly after rectal surgery (59.5%). Postoperative and non-IBD-inflammation associated fistulas had better outcome than IBD-, radiotherapy-, and tumor-related fistulas (p = 0.001). Successful fistula closure was observed more frequently after radical surgical interventions, best results observed after transabdominal surgery (p < 0.001). Fistula recurrence was also less frequently observed after radical surgical therapies (p = 0.029). A temporary stoma was associated with higher incidence of fistula closure (p = 0.013) and lower incidence of fistula recurrence (p = 0.042) in the postoperative subgroup, as well as shortened therapy period in all groups (p = 0.031).

Conclusion

Enterovaginal fistulas are a result of various etiologies, and treatment should be adjusted accordingly. A very sustainable, rapid, and persistent therapeutic success can be expected after radical surgical approaches with temporary diverting stoma. This is especially true for postoperatively derived fistulas.

中文翻译：

肠阴道瘘治疗结果的预测因素

背景

肠阴道瘘是各种疾病和治疗过程的严重并发症，通常与复杂的临床过程和生活质量的严重损害有关。由于潜在的条件和程序多种多样，治疗方法具有挑战性，必须单独定制。由于治疗管理复杂且个体化，可能需要多次手术干预。

方法

本研究的目的是确定肠阴道瘘患者治疗结果的可能预测因素。该研究是通过回顾性分析实现的。对 2004 年至 2016 年间接受肠阴道瘘治疗的 92 名患者进行了分析。根据病因、闭合率和时间以及瘘管复发对患者特征、治疗数据和内窥镜检查结果进行分层。主要结果指标是瘘管闭合的总体率。

结果

总体治疗成功率为67.4%。术后瘘最常见（40.2%），主要发生在直肠手术后（59.5%）。术后和非 IBD 炎症相关的瘘管比 IBD、放疗和肿瘤相关的瘘管具有更好的结果 ( p = 0.001)。根治性手术干预后更频繁地观察到瘘管成功闭合，经腹手术后观察到最佳结果 ( p < 0.001)。根治性手术治疗后，瘘管复发的几率也较低（ p = 0.029）。在术后亚组中，临时造口与较高的瘘管闭合发生率（ p = 0.013）和较低的瘘管复发发生率（ p = 0.042）相关，并且与所有组中的治疗周期缩短相关（ p = 0.031）。