Risk of Rectovaginal Fistula in Women with Excision of Deep Endometriosis Requiring Concomitant Vaginal and Rectal Sutures, with or without Preventive Stoma: A Before-and-after Comparative Study.

Abstract

STUDY OBJECTIVE:

To assess whether a liberal policy of preventive stoma (LPS) reduces the rate of rectovaginal fistulas in women with excision of deep endometriosis requiring concomitant vaginal and rectal sutures in comparison with a more restrictive policy of preventive stoma (RPS) and to assess the risk factors for rectovaginal fistula.

DESIGN:

Retrospective before-and-after comparative study.

SETTING:

Two referral centers, one with an LPS and the other with an RPS.

PATIENTS:

A total of 363 patients with deep endometriosis infiltrating the rectum and the vagina.

INTERVENTIONS:

Rectal disc excision or colorectal resection concomitantly with vaginal excision.

MEASUREMENTS AND MAIN RESULTS:

Two hundred forty-one and 122 women received surgery at the LPS and RPS centers, respectively. The rate of preventive stomas was 71.4% at the LPS center (n = 172) and 30.3% at the RPS center (N = 37). Rectovaginal fistula was recorded in 31 cases (8.5%): nineteen women were managed at the LPS center, and 12 women underwent surgery at the RPS center. It occurred in, respectively, 9.4%, 10.8%, 10.1%, and 7% of the women managed without and with a stoma at the RPS center and of those managed without and with a stoma at the LPS center (p = .72). The height of the rectal stapled line was significantly lower in the women undergoing a stoma, particularly in those managed at the RPS center (5.4 ± 1.8 cm). Performing rectal sutures within 8 cm from the anal verge increased the risk of rectovaginal fistula more than 3-fold, independently of stoma creation, surgical procedure carried out on the rectum, size of vaginal infiltration, or associated excision of deep endometriosis involving the pelvic nerves (odds ratio 3.4; 95% confidence interval, 1.3-9.1).

CONCLUSION:

No statistically significant differences were found in terms of the risk of rectovaginal fistula between women with rectovaginal endometriosis managed by either an LPS or an RPS; however, these findings need to be confirmed by a randomized trial.

• Authors: Horace Roman, Valérie Bridoux, Benjamin Merlot, Myriam Noailles, Eric Magne, Benoit Resch, Damien Forestier, Jean-Jacques Tuech
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) Vol. 29 Issue 1 Pg. 56-64.e1 (01 2022) ISSN: 1553-4669 [Electronic] United States
• PMID: 34175463 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.

Topics

• Endometriosis (complications, surgery)
• Female
• Humans
• Postoperative Complications (etiology, prevention & control)
• Rectal Diseases
• Rectovaginal Fistula (etiology, prevention & control, surgery)
• Rectum
• Retrospective Studies
• Sutures
• Treatment Outcome
• Vagina