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Master Thesis

Rectovaginal fistula in Crohn’s disease: a low long-term success rate and a high definitive stoma risk

Abstract : Management of RVF in CD is challenging, recommended medical treatment is mostly based on biologics, but surgical support still relies on various techniques with no gold standard. Available studies are heterogeneous retrospective ones, with short term follow-up. The aim of this study was to assess results of medico-surgical support in women with rectovaginal fistula (RVF) due to Crohn’s disease (CD) in a tertiary referral center. We conducted a retrospective analysis of women undergoing surgery for CD RVF between 1996 and 2019 in a tertiary referral center. All surgeries were classified as: preliminary, closure techniques or salvage procedures. Primary outcome was fistula remission defined by the combination of fistula closure, absence of symptoms, and no stoma at least 6 months since last procedure. Were included 32 patients, median follow-up was 11.3 years (0-23.7) after first surgery. A total of 138 procedures were performed, 45 (33%) preliminary (drainage +/- seton insertion, diverting stoma), 80 (58%) closure techniques, 13 (9%) salvage procedures leading to planned definitive stoma. RVF remission was obtained in 7/32 patients (22%). Global remission rate per procedure was 5% (5/138), 9% (7/80) with closure techniques alone. At the end of follow up a stoma was present in 13/32 patients (41%). Percentage of time under biologics was 90% for patients in remission, versus 50% for the others (p=0.11). Only biologics were prognostic factor for successful closure techniques (p=0.007) in univariate analysis. RVF remission in CD was low at long term, patients endured a succession of interventions, and definitive stoma rate was high. Combination with biologics was crucial.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03040029
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Friday, December 4, 2020 - 10:22:29 AM
Last modification on : Wednesday, December 9, 2020 - 3:24:30 AM
Long-term archiving on: : Friday, March 5, 2021 - 6:29:06 PM

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  • HAL Id : dumas-03040029, version 1

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Laurine Tracanelli. Rectovaginal fistula in Crohn’s disease: a low long-term success rate and a high definitive stoma risk. Human health and pathology. 2020. ⟨dumas-03040029⟩

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