{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:28:02Z","timestamp":1791520082406,"version":"4.3.4"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Rectovaginal fistula occurs in up to 10\u201320% of women with Crohn\u2019s disease, significantly affecting their quality of life. We sought to determine outcomes of single and repeat operative interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of all adult patients with a Crohn\u2019s-related rectovaginal fistula, who underwent an operation between 1995 and 2021, was performed. Data collected included patient demographics, Crohn\u2019s-related medical treatment, surgical intervention, postoperative outcomes, and fistula outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 166 patients underwent 360 operations; mean age was 42.8 [+\/-13.2] years; 34 [20.7%] patients were current and 58 [35.4%] former smokers. The most commonly performed procedure was: a local approach [n\u2005=\u2005160, 44.5%] using fibrin glue, fistulotomy\/fistulectomy, or seton placement; followed by a transvaginal\/transanal approach [n\u2005=\u2005113, 31.4%] with an advancement flap repair [including Martius advancement flap] and episoproctotomy; a transabdominal approach [n\u2005=\u200598, 27.2%] including proctectomy or re-do anastomosis; and finally gracilis muscle interposition [n\u2005=\u20058, 2.2%]. The median number of operative interventions per patient was 2 [1.0\u20133.0] procedures. The overall fistula healing rate per patient was 71.7% [n\u2005=\u2005119] at a median follow-up of 5.5 [1.2\u20139.8] years. Factors that impaired healing included former smoking (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31\u20130.87, p\u2005=\u20050.014) and seton insertion [OR 0.42, 95% CI 0.21\u20130.83, p\u2005=\u20050.012].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Over two-thirds of Crohn\u2019s-related rectovaginal fistulas can achieve closure with multiple surgical interventions. Smoking and seton usage negatively affect healing rates and should be avoided.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjac151","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T12:22:14Z","timestamp":1665231734000},"page":"396-403","source":"Crossref","is-referenced-by-count":8,"title":["Surgical Intervention is Effective for the Treatment of Crohn\u2019s-related Rectovaginal Fistulas: Experience From a Tertiary Inflammatory Bowel Disease Practice"],"prefix":"10.1093","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0281-8087","authenticated-orcid":false,"given":"Ana M","family":"Otero-Pi\u00f1eiro","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Statistics, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina E","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, Northeast Ohio Medical University , Rootstown, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Hull","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Lipman","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-9042","authenticated-orcid":false,"given":"Stefan","family":"Holubar","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R","family":"Steele","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L","family":"Lightner","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic , Cleveland, OH , 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