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Poster presentations: Clinical: Therapy and Observation 2020

P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients

A. Frontali1, M. Rottoli2, A. Chierici1, G. Poggioli2, Y. Panis3

1Beaujon Hospital, Colorectal Surgery, Clichy, France, 2Ospedale Policlinico di Sant’Orsola-Malpighi, Digestive Surgery, Bologna, Italy, 3APHP Beaujon, Department of Colorectal Surgery, Clichy, France

Background

Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients.

Methods

We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy).

Results

Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196).

Conclusion

Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.