P339. Surgical treatment of female genital fistula in Crohn's disease
L. Franceschilli, I. Capuano, G. Milito, F. Giorgi, A. Gaspari, P. Sileri, University of Rome Tor Vergata, Department of Sperimental medicine and Surgery, Rome, Italy
Treatment of female genital fistula in Crohn's disease remains challenging with exasperating results. Moreover the considerable variety in the clinical presentation as well as the need of several operations necessary to attain definitive healing, homogeneous literature data and guidelines concerning optimal treatment are not available.
In this study we summarize surgical results of female genital fistula treatments in a large consecutive series of patients.
All patients with anorectal or rectovaginal fistula due to Crohn's disease requiring surgery in our institution between 2005 and 2013 were considered. Patient's characteristics, type of fistula and interventions, functional results, and recurrences were classified and analyzed. All data were retrieved from a prospectively collected database.
During the study period, 34 patients with RVF underwent 43 surgical procedure. The patients' median age was 39±8 years; the median follow-up period was 34 months. Surgeries included: endorectal advancement flap (14), endorectal advancement flap with dermal collagen matrix injection (n = 6), advancement vaginal flap (n = 10), martius flap (n = 5), transverse transperineal biological mesh repair (n = 3), ligation of intersphincteric fistula tract-LIFT (3), anocutaneous flap (2). Diverting ileostomies/colostomies were created in 12 patients (35%).
Definitive healing after the initial repair was achieved in 20 patients (59%). Considering repeated procedures, the overall healing rate increased to 68% (23 patients). Recurrence rate was 42%, being immediate after surgery in 24% of the patients. Among the various surgical procedures, the higher success rate was observed after endorectal advancement flap (75%). Number of previous surgery correlates with failure (>3, 100%). At the end of follow-up proctectomy rate was 9%.
This series confirms that recurrence rates after repair of complex fistulas for Crohn's disease are high and continuously increase over time. Sphincter saving approaches should be considered as first attempt.