Rectovaginal fistula: risk factors for failure after graciloplasty: a bicentric retrospective European study in 61 patients

BACKGROUND: Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF) after failure of previous local treatments. The aim of this study was to assess risk factors for GP failure performed for RVF.METHODS: Retrospective study based on a prospective database of GP, coming from two expert centers.RESULTS: 61 patients undergoing a first GP for RVF (n=51) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n=10), with a mean age of 42 years (range, 24-72) were analyzed. After a mean follow-up of 56 ± 48 months (range, 1-183), failure of GP (considered as persistent stoma and/or clinical RVF) was noted in 24/61 patients (39%). Failure rate was 43% (13/30) in case of Crohn's disease, 38% (3/8) in case of ileal-vaginal fistula after IPAA for ulcerative colitis, 30% in case of obstetrical RVF (3/10), 33% in case of post radiotherapy RVF (1/3), and 40% for other causes (4/10) (NS). Two risk factors for failure of GP were found on univariate analysis: 1) absence of postoperative antibiotic prophylaxis (PAP): only 3/24 (13%) patients with failure of GP received PAP versus 18/37 (49%) patients with success of GP (p=0.0053); 2) postoperative perineal infection: 11/23 (48%) with failure of GP failure developed postoperative perineal infection versus only 4/37 (10%) patients with success of GP (p=0.0021).CONCLUSIONS: Failure of Graciloplasty for rectovaginal fistula is observed in approximately 40% of the patients whatever the aetiology of the fistula. Reduced failure rate was associated with systematic postoperative antibiotic prophylaxis.