Delayed coloanal anastomosis for rectovaginal fistulas: Insights from a multicenter cohort (GRECCAR).

Abstract

Delayed coloanal anastomosis for treating rectovaginal fistulas focuses on optimizing healing by postponing the coloanal anastomosis until after the vaginal repair. This study aimed to evaluate the success rate, morbidity, and functional outcomes of this strategy. This retrospective study included all patients who underwent delayed coloanal anastomosis for rectovaginal fistula between 2010 and 2023 across 16 GRECCAR-affiliated colorectal centers. A total of 78 patients (median age: 54.5 years) were included. The main cause of rectovaginal fistula was chronic leakage from colorectal or coloanal anastomosis (67%). The median time interval between the rectovaginal fistula diagnosis and delayed coloanal anastomosis was 9.0 months (interquartile range: 5.0-17.0 months). A total of 40% (31 of 78) of patients underwent delayed coloanal anastomosis after the failure of at least 1 previous treatment attempt. The overall morbidity, major morbidity, and anastomotic leakage occurrence after delayed coloanal anastomosis were 45%, 23%, and 17%, respectively. After a median follow-up of 31 months, the success rate of delayed coloanal anastomosis (healing of rectovaginal fistulas with preservation of bowel continuity) was 81% (63 of 78). No preoperative or intraoperative factors, including pelvic radiotherapy (P = .331) or failure of a previous treatments before delayed coloanal anastomosis (P = .982), were predictive of failure. In cases of anastomotic leakage after delayed coloanal anastomosis, the success rate decreased to 23% (3 of 13) compared with the success rate of 92% (60 of 65) in the absence of anastomotic leakage (P < .001). A total of 42% (24 of 57) of patients reported severe low anterior resection syndrome or remained with a stoma because of poor functional outcomes. Delayed coloanal anastomosis demonstrates a high success rate as high as 81% in treating complex rectovaginal fistulas. However, it is linked to significant postoperative morbidity and functional sequelae.