Intestinovaginal fistulae are a rare condition characterized by a fistula between the bowel lumen and vagina, usually in women. These fistulae can occur in the absence of a hysterectomy, though they occur more commonly in women with a prior hysterectomy. The etiology of fistulae include diverticular disease{Aydinli:2016dg}, malignancy, Crohn's disease, or sequelae of radiation therapy.
The treatment of intestinovaginal fistula is surgical. As severe inflammation often infers formidable technical challenges during surgery, these patients are frequently referred for treatment in tertiary centers.
With the observed increasing rates of laparoscopy in the management of diverticulitis, colon cancer, (and Crohn’s patients?)***find reference, we hypothesized that in high-volume centers, the utilization of laparoscopy was also increasing in the treatment of intestinovaginal fistula.
We also hypothesized that the rate of resection and anastomosis without fecal diversion was similar in intestinovaginal fistula compared to patients undergoing surgery for diverticulitis, colon cancer, and Crohn’s disease.
Due to the infrequency of intestinovaginal fistula, our understanding of this condition hails from case reports and small case series. In the present study, we identified all patients the ACS-NSQIP database to glean trends in the surgical management and their complications for this complex condition. Can we identify risk factors to help determine the optimal surgery in these patients, and thereby influence the choice of resection vs fecal diversion, and open vs laparoscopic surgery?
who underwent abdominal surgery (for the principal diagnosis of intestinovaginal fistula (ICD-9 code ***) to determine the surgical approach, type of resection, risk factors, and complications.
A drawback of the ACS-NSQIP database is that only one diagnosis, the principal diagnosis is recorded, which inevitably results in underreporting of these fistulae. Also, we are not able to distinguish the underlying cause for the fistulae; diverticulitis, malignancy, inflammatory bowel disease, or other.
Methods
The ACS-NSQIP includes data related to surgeries from *** hospitals in the United States.
We identified all patients who underwent abdominal surgery for the principal diagnosis of intestinovesical fistula (ICD-9 code ***). These include laparoscopic and open bowel resections of any kind, and fecal diversion. We excluded all perineal procedures, such as perineal repair of rectovaginal fistula.
Statistics
Results
Discussion
Intestinovaginal fistula is rare with accumulated knowledge to date only from case reports and case series. The incidence of diverticulitis is rising in the United States, and as diverticulitis is the most common cause of intestinovaginal fistula, the rates of these fistulas can hence be expected to increase. Surgery is the treatment of choice, unless contraindicated for medical reasons and restoration to full health not feasible.
Laparoscopy rates have been increasing for colon cancer and for diverticulitis, but is the laparoscopy rate for intestinovaginal fistula increasing in the same manner? Stoma rates for colon cancer and diverticulitis are **%, and reported as **% for fistulizing disease.
Complication rates are lower in laparoscopy compared to open surgery for both diverticulitis and colon cancer. This has not been shown in intestinovesical fistula????*** We wished to understand what determines how we surgically treat these patients, and if the laparoscopic approach is safe or safer than open.
Laparoscopy has been shown to be beneficial in many surgical conditions in terms of length of stay, return to work, post-operative pain, etc, but is it beneficial in the management of intestinovesical fistula?
A drawback with ACS-NSQIP is that only one ICD code is recorded for each patient, precluding the question of etiology of the fistula.
Conclusions