Download PDF
Clin Colon Rectal Surg 2022; 35(01): 010-020
DOI: 10.1055/s-0041-1740029
Review Article

Rectovaginal Fistula in Crohn's Disease: When and How to Operate?

Jeremy Meyer
1   Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
2   Medical School, University of Geneva, Genève, Switzerland
,
Frédéric Ris
1   Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
2   Medical School, University of Geneva, Genève, Switzerland
,
Miles Parkes
3   Division of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Justin Davies
4   Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Rectovaginal fistula (RVF) occurring during the course of Crohn's disease (CD) constitutes a therapeutic challenge and is characterized by a high rate of recurrence. To optimize the outcome of CD-related RVF repair, the best conditions for correct healing should be obtained. Remission of CD should be achieved with no active proctitis, the perianal CD activity should be minimized, and local septic complications should be controlled. The objective of surgical repair is to close the fistula tract with minimal recurrence and functional disturbance. Several therapeutic strategies exist and the approach should be tailored to the anatomy of the RVF and the quality of the local supporting tissues. Herein, we review the medical and surgical management of CD-related RVF.

Keywords

inflammatory bowel disease - IBD - fistula - fistulizing - vagina - rectum - rectal - complication - reconstruction - flap - mesh - prosthesis - emerging therapies


Publication History

Article published online:
17 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Randall CW, Vizuete JA, Martinez N. et al. From historical perspectives to modern therapy: a review of current and future biological treatments for Crohn's disease. Therap Adv Gastroenterol 2015; 8 (03) 143-159
    CrossrefPubMedSearch in Google Scholar
  • 2 Penner A, Crohn BB. Perianal fistulae as a complication of regional ileitis. Ann Surg 1938; 108 (05) 867-873
    CrossrefPubMedSearch in Google Scholar
  • 3 Park SH, Aniwan S, Scott Harmsen W. et al. Update on the natural course of fistulizing perianal Crohn's disease in a population-based cohort. Inflamm Bowel Dis 2019; 25 (06) 1054-1060
    CrossrefPubMedSearch in Google Scholar
  • 4 Schwartz DA, Loftus Jr EV, Tremaine WJ. et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122 (04) 875-880
    CrossrefPubMedSearch in Google Scholar
  • 5 Makowiec F, Jehle EC, Starlinger M. Clinical course of perianal fistulas in Crohn's disease. Gut 1995; 37 (05) 696-701
    CrossrefPubMedSearch in Google Scholar
  • 6 Andreani SM, Dang HH, Grondona P, Khan AZ, Edwards DP. Rectovaginal fistula in Crohn's disease. Dis Colon Rectum 2007; 50 (12) 2215-2222
    CrossrefPubMedSearch in Google Scholar
  • 7 Saclarides TJ. Rectovaginal fistula. Surg Clin North Am 2002; 82 (06) 1261-1272
    CrossrefPubMedSearch in Google Scholar
  • 8 Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn's disease. Am J Surg 1997; 173 (02) 95-98
    CrossrefPubMedSearch in Google Scholar
  • 9 Scott NA, Nair A, Hughes LE. Anovaginal and rectovaginal fistula in patients with Crohn's disease. Br J Surg 1992; 79 (12) 1379-1380
    CrossrefPubMedSearch in Google Scholar
  • 10 Athanasiadis S, Yazigi R, Köhler A, Helmes C. Recovery rates and functional results after repair for rectovaginal fistula in Crohn's disease: a comparison of different techniques. Int J Colorectal Dis 2007; 22 (09) 1051-1060
    CrossrefPubMedSearch in Google Scholar
  • 11 Sher ME, Bauer JJ, Gelernt I. Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach. Dis Colon Rectum 1991; 34 (08) 641-648
    CrossrefPubMedSearch in Google Scholar
  • 12 Hesterberg R, Schmidt WU, Müller F, Röher HD. Treatment of anovaginal fistulas with an anocutaneous flap in patients with Crohn's disease. Int J Colorectal Dis 1993; 8 (01) 51-54
    CrossrefPubMedSearch in Google Scholar
  • 13 Löffler T, Welsch T, Mühl S, Hinz U, Schmidt J, Kienle P. Long-term success rate after surgical treatment of anorectal and rectovaginal fistulas in Crohn's disease. Int J Colorectal Dis 2009; 24 (05) 521-526
    CrossrefPubMedSearch in Google Scholar
  • 14 Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM. Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 1988; 31 (02) 94-99
    CrossrefPubMedSearch in Google Scholar
  • 15 Penninckx F, Moneghini D, D'Hoore A, Wyndaele J, Coremans G, Rutgeerts P. Success and failure after repair of rectovaginal fistula in Crohn's disease: analysis of prognostic factors. Colorectal Dis 2001; 3 (06) 406-411
    CrossrefPubMedSearch in Google Scholar
  • 16 Narang R, Hull T, Perrins S, Garcia JS, Wexner SD. Should immunomodulation therapy alter the surgical management in patients with rectovaginal fistula and Crohn's disease?. Dis Colon Rectum 2016; 59 (07) 670-676
    CrossrefPubMedSearch in Google Scholar
  • 17 El-Gazzaz G, Hull T, Mignanelli E, Hammel J, Gurland B, Zutshi M. Analysis of function and predictors of failure in women undergoing repair of Crohn's related rectovaginal fistula. J Gastrointest Surg 2010; 14 (05) 824-829
    CrossrefPubMedSearch in Google Scholar
  • 18 Hannaway CD, Hull TL. Current considerations in the management of rectovaginal fistula from Crohn's disease. Colorectal Dis 2008; 10 (08) 747-755 , discussion 755–756
    CrossrefPubMedSearch in Google Scholar
  • 19 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
    CrossrefPubMedSearch in Google Scholar
  • 20 Whiteford MH, Kilkenny III J, Hyman N. et al; Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum 2005; 48 (07) 1337-1342
    CrossrefPubMedSearch in Google Scholar
  • 21 Corman ML. Anal incontinence following obstetrical injury. Dis Colon Rectum 1985; 28 (02) 86-89
    CrossrefPubMedSearch in Google Scholar
  • 22 Sloots CE, Felt-Bersma RJ, Poen AC, Cuesta MA, Meuwissen SG. Assessment and classification of fistula-in-ano in patients with Crohn's disease by hydrogen peroxide enhanced transanal ultrasound. Int J Colorectal Dis 2001; 16 (05) 292-297
    CrossrefPubMedSearch in Google Scholar
  • 23 Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 2001; 120 (05) 1093-1099
    CrossrefPubMedSearch in Google Scholar
  • 24 Bernstein LH, Frank MS, Brandt LJ, Boley SJ. Healing of perineal Crohn's disease with metronidazole. Gastroenterology 1980; 79 (02) 357-365
    CrossrefPubMedSearch in Google Scholar
  • 25 Brandt LJ, Bernstein LH, Boley SJ, Frank MS. Metronidazole therapy for perineal Crohn's disease: a follow-up study. Gastroenterology 1982; 83 (02) 383-387
    CrossrefPubMedSearch in Google Scholar
  • 26 Solomon MJ, McLeod RS, O'Connor BI, Steinhart AH, Greenberg GR, Cohen Z. Combination of ciprofloxacin and metronidazole in severe perianal Crohn's disease. Clin Gastroenterol 1993;7
    PubMed
  • 27 Dejaco C, Harrer M, Waldhoer T, Miehsler W, Vogelsang H, Reinisch W. Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease. Aliment Pharmacol Ther 2003; 18 (11-12): 1113-1120
    CrossrefPubMedSearch in Google Scholar
  • 28 Maeda Y, Ng SC, Durdey P. et al; Topical Metronidazole in Perianal Crohn's Study Group. Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn's disease. Br J Surg 2010; 97 (09) 1340-1347
    CrossrefPubMedSearch in Google Scholar
  • 29 Thia KT, Mahadevan U, Feagan BG. et al. Ciprofloxacin or metronidazole for the treatment of perianal fistulas in patients with Crohn's disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 2009; 15 (01) 17-24
    CrossrefPubMedSearch in Google Scholar
  • 30 West RL, van der Woude CJ, Hansen BE. et al. Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulae in Crohn's disease with infliximab: a double-blind placebo-controlled study. Aliment Pharmacol Ther 2004; 20 (11-12): 1329-1336
    CrossrefPubMedSearch in Google Scholar
  • 31 Dewint P, Hansen BE, Verhey E. et al. Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn's disease: a randomised, double-blind, placebo controlled trial (ADAFI). Gut 2014; 63 (02) 292-299
    CrossrefPubMedSearch in Google Scholar
  • 32 Lee MJ, Parker CE, Taylor SR. et al. Efficacy of medical therapies for fistulizing Crohn's disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16 (12) 1879-1892
    CrossrefPubMedSearch in Google Scholar
  • 33 McSharry K, Dalzell AM, Leiper K, El-Matary W. Systematic review: the role of tacrolimus in the management of Crohn's disease. Aliment Pharmacol Ther 2011; 34 (11-12): 1282-1294
    CrossrefPubMedSearch in Google Scholar
  • 34 Sandborn WJ, Present DH, Isaacs KL. et al. Tacrolimus for the treatment of fistulas in patients with Crohn's disease: a randomized, placebo-controlled trial. Gastroenterology 2003; 125 (02) 380-388
    CrossrefPubMedSearch in Google Scholar
  • 35 Hart AL, Plamondon S, Kamm MA. Topical tacrolimus in the treatment of perianal Crohn's disease: exploratory randomized controlled trial. Inflamm Bowel Dis 2007; 13 (03) 245-253
    CrossrefPubMedSearch in Google Scholar
  • 36 Chande N, Patton PH, Tsoulis DJ, Thomas BS, MacDonald JK. Azathioprine or 6-mercaptopurine for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2015; (10) CD000067
    PubMedSearch in Google Scholar
  • 37 Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 1980; 302 (18) 981-987
    CrossrefPubMedSearch in Google Scholar
  • 38 Present DH, Rutgeerts P, Targan S. et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999; 340 (18) 1398-1405
    CrossrefPubMedSearch in Google Scholar
  • 39 Sands BE, Anderson FH, Bernstein CN. et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004; 350 (09) 876-885
    CrossrefPubMedSearch in Google Scholar
  • 40 Parsi MA, Lashner BA, Achkar JP, Connor JT, Brzezinski A. Type of fistula determines response to infliximab in patients with fistulous Crohn's disease. Am J Gastroenterol 2004; 99 (03) 445-449
    CrossrefPubMedSearch in Google Scholar
  • 41 van Bodegraven AA, Sloots CE, Felt-Bersma RJ, Meuwissen SG. Endosonographic evidence of persistence of Crohn's disease-associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum 2002; 45 (01) 39-45 , discussion 45–46
    CrossrefPubMedSearch in Google Scholar
  • 42 Sands BE, Blank MA, Patel K, van Deventer SJ. ACCENT II Study. Long-term treatment of rectovaginal fistulas in Crohn's disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol 2004; 2 (10) 912-920
    CrossrefPubMedSearch in Google Scholar
  • 43 Sands BE, Blank MA, Diamond RH, Barrett JP, Van Deventer SJ. Maintenance infliximab does not result in increased abscess development in fistulizing Crohn's disease: results from the ACCENT II study. Aliment Pharmacol Ther 2006; 23 (08) 1127-1136
    CrossrefPubMedSearch in Google Scholar
  • 44 Kaimakliotis P, Simillis C, Harbord M, Kontovounisios C, Rasheed S, Tekkis PP. A systematic review assessing medical treatment for rectovaginal and enterovesical fistulae in Crohn's disease. J Clin Gastroenterol 2016; 50 (09) 714-721
    CrossrefPubMedSearch in Google Scholar
  • 45 Toglia MR, Brubaker L, Wenliang C. Rectovaginal and anovaginal fistulas. UpToDate 2019
    PubMedSearch in Google Scholar
  • 46 Thornton M, Solomon MJ. Long-term indwelling seton for complex anal fistulas in Crohn's disease. Dis Colon Rectum 2005; 48 (03) 459-463
    CrossrefPubMedSearch in Google Scholar
  • 47 Regueiro M, Mardini H. Treatment of perianal fistulizing Crohn's disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 2003; 9 (02) 98-103
    CrossrefPubMedSearch in Google Scholar
  • 48 de Groof EJ, Sahami S, Lucas C, Ponsioen CY, Bemelman WA, Buskens CJ. Treatment of perianal fistula in Crohn's disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis 2016; 18 (07) 667-675
    CrossrefPubMedSearch in Google Scholar
  • 49 Tanaka S, Matsuo K, Sasaki T. et al. Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn's disease: when and how were the seton drains removed?. Hepatogastroenterology 2010; 57 (97) 3-7
    PubMedSearch in Google Scholar
  • 50 Topstad DR, Panaccione R, Heine JA, Johnson DR, MacLean AR, Buie WD. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn's disease: a single center experience. Dis Colon Rectum 2003; 46 (05) 577-583
    CrossrefPubMedSearch in Google Scholar
  • 51 Mishra A, Shah S, Nar AS, Bawa A. The role of fibrin glue in the treatment of high and low fistulas in ano. J Clin Diagn Res 2013; 7 (05) 876-879
    PubMedSearch in Google Scholar
  • 52 Grimaud JC, Munoz-Bongrand N, Siproudhis L. et al; Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif. Fibrin glue is effective healing perianal fistulas in patients with Crohn's disease. Gastroenterology 2010; 138 (07) 2275-2281 , 2281.e1
    CrossrefPubMedSearch in Google Scholar
  • 53 Abel ME, Chiu YS, Russell TR, Volpe PA. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum 1993; 36 (05) 447-449
    CrossrefPubMedSearch in Google Scholar
  • 54 O'Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of Crohn's anorectal fistulas. Dis Colon Rectum 2006; 49 (10) 1569-1573
    CrossrefPubMedSearch in Google Scholar
  • 55 Schwandner O, Stadler F, Dietl O, Wirsching RP, Fuerst A. Initial experience on efficacy in closure of cryptoglandular and Crohn's transsphincteric fistulas by the use of the anal fistula plug. Int J Colorectal Dis 2008; 23 (03) 319-324
    CrossrefPubMedSearch in Google Scholar
  • 56 Nasseri Y, Cassella L, Berns M, Zaghiyan K, Cohen J. The anal fistula plug in Crohn's disease patients with fistula-in-ano: a systematic review. Colorectal Dis 2016; 18 (04) 351-356
    CrossrefPubMedSearch in Google Scholar
  • 57 Gajsek U, McArthur DR, Sagar PM. Long-term efficacy of the button fistula plug in the treatment of ileal pouch-vaginal and Crohn's-related rectovaginal fistulas. Dis Colon Rectum 2011; 54 (08) 999-1002
    CrossrefPubMedSearch in Google Scholar
  • 58 Bondi J, Avdagic J, Karlbom U. et al. Randomized clinical trial comparing collagen plug and advancement flap for trans-sphincteric anal fistula. Br J Surg 2017; 104 (09) 1160-1166
    CrossrefPubMedSearch in Google Scholar
  • 59 Allan A, Keighley MR. Management of perianal Crohn's disease. World J Surg 1988; 12 (02) 198-202
    CrossrefPubMedSearch in Google Scholar
  • 60 Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 1980; 21 (06) 525-527
    CrossrefPubMedSearch in Google Scholar
  • 61 Beksac K, Tanacan A, Ozgul N, Beksac MS. Treatment of rectovaginal fistula using sphincteroplasty and fistulectomy. Obstet Gynecol Int 2018; 2018: 5298214
    CrossrefPubMedSearch in Google Scholar
  • 62 Hull TL, El-Gazzaz G, Gurland B, Church J, Zutshi M. Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin. Dis Colon Rectum 2011; 54 (01) 54-59
    CrossrefPubMedSearch in Google Scholar
  • 63 Valente MA, Hull TL. Contemporary surgical management of rectovaginal fistula in Crohn's disease. World J Gastrointest Pathophysiol 2014; 5 (04) 487-495
    CrossrefPubMedSearch in Google Scholar
  • 64 Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn's disease. Br J Surg 1998; 85 (12) 1695-1698
    CrossrefPubMedSearch in Google Scholar
  • 65 Makowiec F, Jehle EC, Becker HD, Starlinger M. Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease. Br J Surg 1995; 82 (05) 603-606
    CrossrefPubMedSearch in Google Scholar
  • 66 Bessi G, Siproudhis L, Merlini l'Héritier A. et al. Advancement flap procedure in Crohn and non-Crohn perineal fistulas: a simple surgical approach. Colorectal Dis 2019; 21 (01) 66-72
    CrossrefPubMedSearch in Google Scholar
  • 67 Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I. Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease. Ann Surg 1991; 213 (02) 151-158
    CrossrefPubMedSearch in Google Scholar
  • 68 Ruffolo C, Scarpa M, Bassi N, Angriman I. A systematic review on advancement flaps for rectovaginal fistula in Crohn's disease: transrectal vs transvaginal approach. Colorectal Dis 2010; 12 (12) 1183-1191
    CrossrefPubMedSearch in Google Scholar
  • 69 Byron Jr RL, Ostergard DR. Sartorius muscle interposition for the treatment of the radiation-induced vaginal fistula. Am J Obstet Gynecol 1969; 104 (01) 104-107
    CrossrefPubMedSearch in Google Scholar
  • 70 Korsun S, Liebig-Hoerl G, Fuerst A. Gracilis muscle transposition for treatment of recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease. Tech Coloproctol 2019; 23 (01) 43-52
    CrossrefPubMedSearch in Google Scholar
  • 71 Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg 2008; 248 (01) 39-43
    CrossrefPubMedSearch in Google Scholar
  • 72 Rius J, Nessim A, Nogueras JJ, Wexner SD. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease. Eur J Surg 2000; 166 (03) 218-222
    CrossrefPubMedSearch in Google Scholar
  • 73 Ulrich D, Roos J, Jakse G, Pallua N. Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Reconstr Aesthet Surg 2009; 62 (03) 352-356
    CrossrefPubMedSearch in Google Scholar
  • 74 Kersting S, Athanasiadis CJ, Jung KP, Berg E. Operative results, sexual function and quality of life after gracilis muscle transposition in complex rectovaginal fistulas. Colorectal Dis 2019; 21 (12) 1429-1437
    CrossrefPubMedSearch in Google Scholar
  • 75 Fürst A, Schmidbauer C, Swol-Ben J, Iesalnieks I, Schwandner O, Agha A. Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn's disease. Int J Colorectal Dis 2008; 23 (04) 349-353
    CrossrefPubMedSearch in Google Scholar
  • 76 McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectovaginal fistula. Am J Surg 2007; 193 (05) 597-599 , discussion 599
    CrossrefPubMedSearch in Google Scholar
  • 77 Gallo G, Realis Luc A, Clerico G, Trompetto M. Martius' flap for recurrent perineal and rectovaginal fistulae in a patient with Crohn's disease, endometriosis and a Mullerian anomaly. BMC Surg 2017; 17 (01) 107
    CrossrefPubMedSearch in Google Scholar
  • 78 Pitel S, Lefevre JH, Parc Y, Chafai N, Shields C, Tiret E. Martius advancement flap for low rectovaginal fistula: short- and long-term results. Colorectal Dis 2011; 13 (06) e112-e115
    CrossrefPubMedSearch in Google Scholar
  • 79 Onodera H, Nagayama S, Kohmoto I, Maetani S, Imamura M. Novel surgical repair with bilateral gluteus muscle patching for intractable rectovaginal fistula. Tech Coloproctol 2003; 7 (03) 198-202
    CrossrefPubMedSearch in Google Scholar
  • 80 de Bruijn H, Maeda Y, Murphy J, Warusavitarne J, Vaizey CJ. Combined laparoscopic and perineal approach to omental interposition repair of complex rectovaginal fistula. Dis Colon Rectum 2018; 61 (01) 140-143
    CrossrefPubMedSearch in Google Scholar
  • 81 van der Hagen SJ, Soeters PB, Baeten CG, van Gemert WG. Laparoscopic fistula excision and omentoplasty for high rectovaginal fistulas: a prospective study of 40 patients. Int J Colorectal Dis 2011; 26 (11) 1463-1467
    CrossrefPubMedSearch in Google Scholar
  • 82 Schloericke E, Zimmermann M, Benecke C. et al. Surgical management of complicated rectovaginal fistulas and the role of omentoplasty. Tech Coloproctol 2017; 21 (12) 945-952
    CrossrefPubMedSearch in Google Scholar
  • 83 Moore RD, Miklos JR, Kohli N. Rectovaginal fistula repair using a porcine dermal graft. Obstet Gynecol 2004; 104 (5 Pt 2): 1165-1167
    CrossrefPubMedSearch in Google Scholar
  • 84 Pye PK, Dada T, Duthie G, Phillips K. Surgisistrade mark mesh: a novel approach to repair of a recurrent rectovaginal fistula. Dis Colon Rectum 2004; 47 (09) 1554-1556
    CrossrefPubMedSearch in Google Scholar
  • 85 Shelton AA, Welton ML. Transperineal repair of persistent rectovaginal fistulas using an acellular cadaveric dermal graft (AlloDerm). Dis Colon Rectum 2006; 49 (09) 1454-1457
    CrossrefPubMedSearch in Google Scholar
  • 86 Schwandner O, Fuerst A. Preliminary results on efficacy in closure of transsphincteric and rectovaginal fistulas associated with Crohn's disease using new biomaterials. Surg Innov 2009; 16 (02) 162-168
    CrossrefPubMedSearch in Google Scholar
  • 87 Schwandner O, Fuerst A, Kunstreich K, Scherer R. Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 2009; 13 (02) 135-140
    CrossrefPubMedSearch in Google Scholar
  • 88 Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum 2008; 51 (07) 1084-1088
    CrossrefPubMedSearch in Google Scholar
  • 89 Hull TL. Expert commentary on the evaluation and management of rectovaginal fistulas. Dis Colon Rectum 2018; 61 (01) 24-26
    CrossrefPubMedSearch in Google Scholar
  • 90 Harper PH, Kettlewell MG, Lee EC. The effect of split ileostomy on perianal Crohn's disease. Br J Surg 1982; 69 (10) 608-610
    CrossrefPubMedSearch in Google Scholar
  • 91 Mueller MH, Geis M, Glatzle J. et al. Risk of fecal diversion in complicated perianal Crohn's disease. J Gastrointest Surg 2007; 11 (04) 529-537
    CrossrefPubMedSearch in Google Scholar
  • 92 Singh S, Ding NS, Mathis KL. et al. Systematic review with meta-analysis: faecal diversion for management of perianal Crohn's disease. Aliment Pharmacol Ther 2015; 42 (07) 783-792
    CrossrefPubMedSearch in Google Scholar
  • 93 Burke JP. Role of fecal diversion in complex Crohn's disease. Clin Colon Rectal Surg 2019; 32 (04) 273-279
    Thieme ConnectPubMedSearch in Google Scholar
  • 94 Heyen F, Winslet MC, Andrews H, Alexander-Williams J, Keighley MR. Vaginal fistulas in Crohn's disease. Dis Colon Rectum 1989; 32 (05) 379-383
    CrossrefPubMedSearch in Google Scholar
  • 95 Mizuno H, Zuk PA, Zhu M, Lorenz HP, Benhaim P, Hedrick MH. Myogenic differentiation by human processed lipoaspirate cells. Plast Reconstr Surg 2002; 109 (01) 199-209 , discussion 210–211
    CrossrefPubMedSearch in Google Scholar
  • 96 Zuk PA, Zhu M, Mizuno H. et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 2001; 7 (02) 211-228
    CrossrefPubMedSearch in Google Scholar
  • 97 Sanz-Baro R, García-Arranz M, Guadalajara H, de la Quintana P, Herreros MD, García-Olmo D. First-in-human case study: pregnancy in women with Crohn's perianal fistula treated with adipose-derived stem cells: a safety study. Stem Cells Transl Med 2015; 4 (06) 598-602
    CrossrefPubMedSearch in Google Scholar
  • 98 de la Portilla F, Alba F, García-Olmo D, Herrerías JM, González FX, Galindo A. Expanded allogeneic adipose-derived stem cells (eASCs) for the treatment of complex perianal fistula in Crohn's disease: results from a multicenter phase I/IIa clinical trial. Int J Colorectal Dis 2013; 28 (03) 313-323
    CrossrefPubMedSearch in Google Scholar
  • 99 Garcia-Olmo D, Herreros D, Pascual I. et al. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 2009; 52 (01) 79-86
    CrossrefPubMedSearch in Google Scholar
  • 100 Panés J, García-Olmo D, Van Assche G. et al; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet 2016; 388 (10051): 1281-1290
    CrossrefPubMedSearch in Google Scholar
  • 101 García-Olmo D, García-Arranz M, García LG. et al. Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn's disease: a new cell-based therapy. Int J Colorectal Dis 2003; 18 (05) 451-454
    CrossrefPubMedSearch in Google Scholar
  • 102 Drumond DG, Chebli JMF, Speck NMG. et al. Case report: treatment for rectovaginal fistula in Crohn's disease using fractionate CO2 vaginal laser with anti-TNF therapy. Photobiomodul Photomed Laser Surg 2019; 37 (07) 451-454
    CrossrefPubMedSearch in Google Scholar
  • 103 DeLeon MF, Hull TL. Treatment strategies in Crohn's-associated rectovaginal fistula. Clin Colon Rectal Surg 2019; 32 (04) 261-267
    Thieme ConnectPubMedSearch in Google Scholar