Clinical and patient-reported outcomes after Martius flap repair of rectovaginal fistula

Abstract

Aims: Rectovaginal fistula (RVF) is a highly challenging disease that is difficult to treat in the clinic and has a considerable risk of recurrence. This study aims to examine the disease course of RVF and evaluate the impact of surgical intervention on patients’ quality of life.Methods: In this two center retrospective case series, patients who underwent Martius flap procedure for RVF between January 2021 and November 2022 were evaluated. Clinical data, including preoperative medical history and physical examination findings were collected from patient records. Postoperative outcomes were assessed using the Cleveland Clinic incontinence score (CCIS) and the fecal incontinence quality of life (FIQL) questionnaire to measure changes in continence and the impact on daily living.Results: A total of 22 patients underwent Martius flap repair. The mean age was 48.2 years. The mean follow-up duration was 34.3 months (range, 26-45 months). The most common etiology was inflammatory bowel disease (31.8%), followed equally by iatrogenic causes and obstetric trauma (27.3% each). Primary healing after the initial repair was achieved in 18 patients (81.8%). Four patients (18.2%) developed recurrence and underwent reoperation; three subsequently achieved complete healing. Overall, 21 of 22 patients achieved complete healing, while one patient had a persistent fistula despite reoperation. Postoperative complications occurred in seven patients (31.8%). The median CCIS decreased from 6.0 to 3.0 (p=0.0041), and the median FIQL score increased from 54.5 to 92.5 (p