Background: Despite measures taken to control traditional risk factors like increased rectal disease activity, anorectal stenosis, and, to a lesser extent, obesity, rates of poor outcomes after rectovaginal fistula (RVF) surgery in women with Crohn’s disease (CD) are still high and require further elucidation. To bridge the gap, we sought to identify risk factors beyond the aforementioned determinants that may be associated with poor outcomes in these patients.Methods: We designed a retrospective, unmatched, case-control study to test our hypothesis. The population comprised women with CD who underwent RVF surgery between the years of 2000 and 2013. Cases were defined as surgeries with an unsuccessful outcome at 4 weeks post-surgery, and controls represented those with a successful outcome at 4 weeks post-surgery. With multivariable logistic regression models, we sought to identify pertinent risk factors for poor outcomes after RVF surgery in these women.Results: Of the 108 women with CD who were referred to our institution for evaluation of RVFs between 2000 and 2013, 39 underwent a total of 63 surgeries, of which 16 were cases and 47 were controls. There were no significant differences between them with regard to medications and clinical or mucosal disease severity, but a significantly higher proportion of poor outcomes arose from the group of women who underwent a mucosal flap procedure (88%) compared to those who had a seton placed (13%; P = 0.0004). The final adjusted logistic regression model demonstrated that women who underwent a mucosal flap procedure instead of a seton placement were 17.5 times more likely to have a poor surgical outcome (odds ratio (OR): 17.51; 95% confidence interval (CI): 3.12 - 98.43; P = 0.0012). Moreover, it was seen that women with active colonic mucosal disease, independent of rectal disease activity, were 4.4 times more likely to have a poor outcome (OR: 4.40; 95% CI: 1.06 - 18.26).Conclusion: Mucosal flap procedures, representing the second, or definitive, stage in surgical treatment of RVF are associated with much worse outcomes and therefore should be preceded by aggressive medical optimization of the patient.J Clin Med Res. 2016;8(2):126-129doi: http://dx.doi.org/10.14740/jocmr2421w
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机译：背景：尽管采取了措施来控制传统的危险因素，例如增加直肠疾病的活动性，肛门直肠狭窄以及在较小程度上的肥胖症，但克罗恩病（CD）的妇女在直肠阴道瘘（RVF）手术后的不良结局率仍然很高并需要进一步阐明。为了弥合差距，我们力图找出可能导致这些患者预后不良的因素以外的危险因素。方法：我们设计了一项回顾性，无与伦比的病例对照研究以检验我们的假设。人群包括在2000年至2013年间接受RVF手术的CD患者。病例定义为在手术后4周未成功手术的患者，而对照组则是在手术后4周成功手术的患者。通过多变量logistic回归模型，我们试图确定这些女性RVF手术后结局不良的相关危险因素。结果：在2000年至2013年间转诊至我们机构评估RVF的108名CD患者中，有39名接受了63例手术中，其中16例为病例，47例为对照。药物和临床或粘膜疾病的严重程度之间没有显着差异，但是与进行了seton放置的妇女相比，经历了粘膜皮瓣手术的女性人群中不良结果的比例显着更高（88％） （13％; P = 0.0004）。最终的调整后的Logistic回归模型表明，进行了粘膜皮瓣手术而不是使用Seton手术的妇女手术效果差的可能性高17.5倍（几率（OR）：17.51; 95％置信区间（CI）：3.12- 98.43; P = 0.0012）。此外，已发现患有活动性结肠粘膜疾病的妇女与直肠疾病活动无关，其不良结局的可能性高4.4倍（OR：4.40; 95％CI：1.06-18.26）。 RVF的外科治疗的第二个阶段（即确定的阶段）与较差的结局相关，因此，应在患者积极进行医学优化之前进行。 2016; 8（2）：126-129doi：http://dx.doi.org/10.14740/jocmr2421w
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