SURGICAL APPROACHES TO LOW ANOVAGINAL FISTULA IN CROHNS-DISEASE

BACKGROUND: Anovaginal fistula due to Crohn's disease can be surgicall y repaired in some women, The purpose of this study was to analyze the types of fistula along with the features that point to success or fai lure in treating these patients, METHODS: Women with anovaginal fistul a and Crohn's disease treated surgically by one surgeon from 1988 to 1 992 were retrospectively studied. RESULTS: Forty-eight women underwent treatment for anovaginal fistula caused by Crohn's disease. This repr esented 55% of the total patients seen for anovaginal fistula from all causes, Nine patients had severe anorectal and/or colonic disease and underwent total proctocolectomy with ileostomy. Four other patients h ad seton placement only. The remaining 35 patients underwent transanal repair of their fistula and are the basis of this study. Three types of flap repairs were performed: curvilinear advancement rectal flap (n = 24), linear advancement rectal flap (n = 6), and advancement sleeve flap (n = 5). The type of surgery selected depended on the associated anal and colorectal disease. Diverting ileostomies were used in nine patients with a successful out-come in eight. Healing occurred with th e initial repair in 19/35 (54%). An additional five patients underwent successful repeat procedures for an overall success rate of 24/35 (68 %), CONCLUSION: Surgical closure of anovaginal can be offered to selec ted women with Crohn's disease, thus avoiding a permanent stoma in thi s group, The type of flap chosen for repair depends on the characteris tics of the fistula. (C) 1997 by Excerpta Medica, Inc.