Table 1 Characteristics of papers included in the SLR (n = 16 studies)
Author, year | Country, location | Inclusion criteria | Exclusion criteria | Fistula type | Sample size | Intervention(s) | Risk of bias (ROBINS-I) |
|---|---|---|---|---|---|---|---|
Corte, 2015 [9] | France, Beaujon Hospital, Paris | Women undergoing surgery for RVF (1996–2014), includes multiple etiologies (CD, post-operative, obstetrical, post-radiation, pelvic cancer, diverticulitis, trauma, unknown) | Not reported | RVF | 79 RVFs | Conservative procedures: seton drainage, vaginal advancement flap, rectal advancement flap, diverting stoma only, fistula plug, fibrin glue Major procedures: GMT, biomesh interposition, standard CAA or CRA, delayed CAA, abdominoperineal excision | Moderate |
El-Gazzaz, 2010 [14] | USAa | Women with CD-related RVF who underwent surgical repair with intent to close the fistula from 1997 to 2007 | Surgical procedures not intended for fistula closure (e.g., seton placement, diverting stoma alone, or definitive proctectomy without reconstruction) | RVF | 65 RVFs | Advancement flap, CAA, episioproctotomy, fibrin glue, plug | Moderate (ClinRO) Serious (PRO) |
Gaertner, 2011 [15] | USAb | Women with CD who underwent operative treatment for RVF between March 1998 and December 2005 | Perianal fistula | RVF | 51 RVFs | Operative treatment, operative treatment + infliximab | Moderate |
Göttgens, 2017 [27] | Netherlands, IBDSL registry | Women with CD diagnosed January 1991–July 2011 at age ≥ 18 years | Not reported | RVF | 17 RVFs | N/A | Low |
Haennig, 2015 [10] | France, gastroenterology department, Hôpital Rangueil, Toulouse | Women with a perianal CD anorectal or vaginal fistula referred between 2000 and 2010 | Patients with follow-up < 6 months or with enteric fistula or ECF | RVF | 12 RVF | Seton drainage and associated treatment, infliximab, external drainage, fibrin glue, advancement flap, fistulotomy Other treatments (external drainage + infliximab, fistulotomy + infliximab, advancement flap + infliximab, infliximab [monotherapy], external drainage, bowel diversion) | Moderate |
Jarrar, 2011 [16] | USA, Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH | Women who underwent transanal endorectal advancement flap repair of complexc anal fistula by the same surgeon from 1995 to 2005 | Patients with subcutaneous and superficial trans-sphincteric fistulas treated with fistulotomy alone or fistulotomy and a cutting seton | AVF | 21 AVFs | Transanal endorectal advancement flap repair | Moderate |
Korsun, 2019 [17] | Germany, surgery departments of the University Hospital Regensburg and the St Josef Hospital Regensburg | Women with AVF, RVF, rectourethral fistulas, or pouch-vaginal fistulas and diagnosed with IBD who underwent GMT or re-transposition for a recurrent fistula between January 2000 and May 2018 | Patients with IBD who underwent GMT strictly owing to fecal incontinence and not for fistula treatment | RVF | 21 RVFs 2 AVFs | GMT | Moderate |
Manne, 2016 [26] | USA, Department of Medicine—Gastroenterology, University of Alabama at Birmingham, Alabama | Women with CD who underwent RVF surgery (either mucosal flap surgery or seton placement) between 2000 and 2013 for whom key demographic and medical history data were available | Not reported | RVF | 16 surgeries | Mucosal flap procedure, seton | Critical |
Milito, 2019 [18] | Italy, University Hospital of Tor Vergata, Rome | Women with CD who underwent surgery for an RVF performed by the same senior surgeon at a tertiary center | Not reported | RVF | 43 RVFs | Surgical procedures for RVF (surgical approaches included drainage and seton, rectal advancement flap, vaginal advancement flap, transperineal approach using porcine dermal matrix, and Martius flap) | No information |
Narang, 2016 [19] | USAd | All women who underwent RVF repair from July 1997 to June 2013 at two major tertiary referral centers Women who had recurrent symptoms at the time of the telephone survey but who had not visited their surgeon for full evaluation | Patients who did not agree to participate in the telephone follow-up survey or could not be reached | RVF | 99 RVFs | Episioproctotomy, muscle interposition (including GMT and Martius flap), placement of biological plug and fibrin glue, rectal-advancement flap, sphincteroplasty, and transvaginal repair | Serious |
Oakley, 2015 [20] | USAe | Possible cases of RVFs identified using ICD-9 codes of female genital digestive tract fistula July 2006–June 2011. Outpatient records with relevant ICD codesf | Charts with missing data for diagnosis or management | RVF | 106 RVFs 50 AVFs 20 unspecified RVFs or AVFs | N/A | Serious |
Park, 2019 [21] | USA, Olmsted Medical Center, Mayo Medical Center,Rochester MN | Women diagnosed with CD from 1970 to 2010 | Not reported | RVF AVF | 13 RVFs or AVFs | N/A | Low |
Pinto, 2010 [22] | USAg | Women who underwent RVF repairs from January 1988 to May 2008 and who were surgically treated for AVFs and pouch vaginal fistulas | Patients with a rectourethral or anoperineal fistula; treated with only a diverting stoma; had < 3 months’ follow-up time; had a history of proctectomy or Hartmann procedure | RVF | 45 of 125 RVFs were CD related | Endorectal advancement flap, GMT, transvaginal approach, transperineal approach | Moderate |
Sapci, 2019 [23] | USA, surgical center not specified | Women diagnosed with CD who underwent surgery for RVF between 2010 and 2017 | Surgery without intent to close the fistula; < 6 months’ follow-up; inadequate follow-up to verify fistula status | RVF | 19 RVFs | Procedures to definitively close RVF: transanal advancement flap, transanal repair with tissue interposition (Martius or gracilis flap), episioproctotomy, fistulotomy, CAA, fistula plug | Moderate |
Schloericke, 2017 [24] | Germany, Department of Surgery, University of Schleswig–Holstein, Campus Luebeck and Department of Surgery, WKK Heide | Women who underwent treatment for AVF or RVF in the period January 2000 to September 2016 | Not reported | RVF | 58 RVFs | Non-resective procedures (transrectal/transvaginal omentoplasty or closure); resective procedures (low anterior resection, subtotal colectomy, proctectomy, pelvic exenteration, double-barrel sigmoidostomy) | Moderate |
Schwartz, 2019 [25] | USA | Cases of CD (≤ 1 claim of CD-related ICD-9 code in recent 5-year history) identified through December 31, 2014 with codes for fistulizing disease (identified by ICD-9 and surgical codes) in the Truven Health MarketScan database | Not reported | RVF | N/A | N/A | Moderate |