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Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer - occurrence and risk factors.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Linköping University Hospital, Linköping, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2010 (English)In: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, ISSN 1463-1318, Vol. 12, no 4, 351-357 p.Article in journal (Refereed) Published
Abstract [en]

ABSTRACT Background The aim of the study was to assess recto-vaginal fistula after anterior resection of the rectum for cancer with regard to occurrence and risk factors. Methods All female patients (median age 69.5 years, UICC cancer stage IV in 10%) who developed a symptomatic recto-vaginal fistula (n=20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n=32), and those who did not leak (n=338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for recto-vaginal fistula (anastomotic-vaginal fistula) were analysed. Results Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL) of faeces. Patients with AVF required unscheduled reoperation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis <5cm above the anal verge (P=0.001), preoperative radiotherapy (P=0.004), and UICC cancer stage IV (P=0.005). Previous hysterectomy was not a risk factor for AVF nor for CL. Conclusion Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal reoperation and defunctioning stoma was not different from patients with conventional leakage. Risk factors for anastomotic-vaginal fistula included low anastomosis, preoperative radiotherapy, and UICC cancer stage IV.

Place, publisher, year, edition, pages
2010. Vol. 12, no 4, 351-357 p.
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-22346DOI: 10.1111/j.1463-1318.2009.01798.xPubMedID: 19220383OAI: oai:DiVA.org:umu-22346DiVA: diva2:214590
Available from: 2009-05-06 Created: 2009-05-06 Last updated: 2011-10-20Bibliographically approved

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