Assessment of the efficacy of the rectovaginal button fistula plug for the treatment of ileal pouch-vaginal and rectovaginal fistulas.

Abstract

BACKGROUND:

The treatment of rectovaginal and ileal pouch-vaginal fistulas remains a challenging problem for the colorectal surgeon. The aim of this study was to assess the short-term efficacy of the new Surgisis Biodesign rectovaginal button fistula plug in patients with such fistulas.

METHODS:

Between May 2008 and September 2008, patients with confirmed rectovaginal and ileal pouch-vaginal fistulas with backgrounds of inflammatory bowel disease were treated with the button fistula plug. The fistulas were assessed by magnetic resonance imaging and/or examination under anesthesia before the procedure.

RESULTS:

Twelve patients with a median age of 36 (range, 29-42) years underwent a total of 20 plug insertions. Five patients had confirmed rectovaginal fistulas and seven patients had ileal pouch-vaginal fistulas. At a median follow-up of 15 (interquartile range, 10-21) weeks, 7 of 12 patients (58%) had been treated successfully. Seven of the 20 plugs that were inserted (35%) were successful. This equates to the successful treatment of three of five (60%) of the rectovaginal fistulas, and four of seven (57%) of the ileal pouch-vaginal fistulas. Of the six patients who initially failed, a repeat procedure was performed of which one was successful. Two patients underwent a third repeat procedure, which was again unsuccessful in both cases. The success rate of these eight repeat plug insertions was therefore 12.5%. All plug failures were the result of dislodgement of the plug. There was no morbidity in our series.

CONCLUSIONS:

The new button fistula plug successfully treated 7 of 12 (58%) rectovaginal and ileal pouch-vaginal fistulas.

• Authors: Simon Gonsalves, Peter Sagar, John Lengyel, Charles Morrison, Richard Dunham
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 52 Issue 11 Pg. 1877-81 (Nov 2009) ISSN: 1530-0358 [Electronic] United States
• PMID: 19966636 (Publication Type: Journal Article)

Topics

• Absorbable Implants
• Adult
• Biological Dressings
• Colonic Pouches (adverse effects)
• Crohn Disease (complications, surgery)
• Female
• Humans
• Magnetic Resonance Imaging
• Rectovaginal Fistula (surgery)
• Tampons, Surgical
• Treatment Outcome
• Vaginal Fistula (surgery)