REPAIR OF THE PROBLEMATIC COMPLEX RECTOVAGINAL FISTULA USING BOVINE INTESTINAL SUBMUCOSA,

Purpose:  Recurrent rectovaginal fistula occurring in conjunction with ileal J-pouch, irradiation, or Crohn’s Disease creates a uniquely challenging surgical problem.  We report an initial experience using an absorbable bovine intestinal submucosa biomembrane (Surgicist®) in the treatment of five problematic, complex, recurrent fistulas. 

Methods:  Five patients with recurrent rectovaginal fistulas:  2 with ileal J-pouch; 1 with Crohn’s; 1 post-irradiation; and 1 with post-partum sphincter disruption, were treated with biomembrane (Surgicist®) interposition augmenting conventional surgical repair.  Patients’ ages ranged from 38 to 79 years.  All had between 1 and 4 prior repairs, and the fistulas’ openings measured between 0.1 and 1 cm.  One patient had a pre-existing diverting colostomy. 

Results:  There was no mortality or intraoperative morbidity.  A single postoperative wound infection responded to drainage.  In a follow-up period of 1 to 5 months, 4 of the patients’ repairs were intact.  In the failed ileal J-pouch vaginal fistula, there is an 80% decrease in the fistula size.  Good continence is maintained in all. 

Conclusions:  The results of our initial limited, early experience using a resorbable biomembrane (Surgicist®) as a reinforcement to conventional surgical repair in the most challenging problematic rectovaginal fistulas is sufficiently promising to warrant further investigation.

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