Stapled transperineal repair for low- and mid-level rectovaginal fistulas: A 5-year experience and comparison with sutured repair

Table 1 Clinical characteristics of the patient groups

Variable	Group 1	Group 2	Test value	P value
	n = 37	n = 45
Age1, yr, n (%)			χ² = 2.139	0.235
< 60	32 (86.49)	43 (95.56)
≥ 60	5 (13.51)	2 (4.44)
Aetiology1, n (%)			χ² = 8.601	0.025
Congenital	5 (13.51)	13 (28.89)
Obstetrical	15 (40.54)	24 (53.33)
Secondary to surgery	16 (43.24)	8 (17.78)
Other (traumatic aetiology)	1 (2.7)	0 (0)
Fistula duration time2, mo	91.1 ± 128.38	126.24 ± 150.85	U = 695	0.199
Previous repair history1, n (%)			χ² = 1.311	0.515
0	26 (70.27)	31 (68.89)
1	8 (21.62)	7 (15.56)
≥ 2	3 (8.11)	7 (15.56)
Fistula location1, n (%)			χ² = 1.072	0.351
Low-level	27 (72.97)	28 (62.22)
Mid-level	10 (27.03)	17 (37.78)
Distance from anal margin2, cm	2.16 ± 1.53	2.34 ± 1.16	U = 750.5	0.443
Distance from vaginal introitus2, cm	1.65 ± 1.32	1.84 ± 1.13	U = 692.5	0.188
Diameter of fistula2, cm	0.78 ± 0.47	0.62 ± 0.43	U = 639.5	0.069
Stoma1, n (%)	5 (13.51)	7 (15.56)	χ² = 0.068	1
Preoperative Wexner score2	7.03 ± 3.45	6.69 ± 3.48	t = 0.614	0.541

¹Categorical data presented as number and percentage of patients in each group.

²Measurement data presented as mean ± SD. Group 1: Direct sutured rectovaginal fistula patients; Group 2: Stapled rectovaginal fistula patients. χ²: Chi-squared testing; U: Mann-Whitney U testing.

Table 2 Operative and postoperative parameters—comparison between groups

Variable	Group 1	Group 2	Test value	P value
	n = 37	n = 45
Operative time1, min	74.84 ± 29.24	84.47 ± 33.46	U = 705	0.233
Blood loss1, mL	24.38 ± 17.05	23.89 ± 20.42	U = 779.5	0.613
Hospital stay1, d	14.19 ± 5.44	14.04 ± 4.54	t = 0.131	0.896
Postoperative Wexner score1	2.73 ± 3.75	1.04 ± 1.89	U = 610	0.021
Recurrence2, n (%)	17 (45.95)	6 (13.33)	χ² = 10.701	0.001

¹Measurement data presented as mean ± standard variance.

²Categorical data presented as number and percentage of patients in each group. Group 1: Direct sutured rectovaginal fistula patients; Group 2: Stapled rectovaginal fistula patients. χ²: Chi-squared testing; U: Mann-Whitney U testing.

Table 3 Univariate analysis of risk factors for fistula recurrence

Variable	Recurrent RVF	Non-recurrent RVF	P value
Age, yr, n (%)			0.655
< 60	22 (95.65)	55 (93.33)
≥ 60	1 (4.35)	4 (6.78)
Aetiology, n (%)			0.203
Congenital	6 (26.09)	12 (20.34)
Obstetrical	7 (30.43)	32 (54.24)
Secondary to surgery	10 (43.48)	14 (23.73)
Other	0 (0)	1 (1.69)
Fistula duration time, mo, n (%)			0.289
< 24	14 (60.87)	29 (49.15)
≥ 24	9 (39.13)	30 (50.85)
Previous repair history, n (%)			0.037
0	12 (52.13)	45 (76.27)
≥ 1	11 (47.83)	14 (23.73)
Fistula location, n (%)			0.804
Low-level	15 (65.22)	40 (67.8)
Mid-level	8 (34.78)	19 (32.2)
Diameter of fistula, cm, n (%)			0.039
< 0.5	3 (13.04)	22 (37.29)
≥ 0.5	20 (86.96)	37 (62.71)
Stoma, n (%)			0.068
Yes	17 (73.91)	53 (89.83)
No	6 (26.09)	6 (10.17)
Surgical approach, n (%)			0.002
Conventional suture repair	17 (73.91)	20 (33.9)
Stapled repair	6 (26.09)	39 (66.1)
Preoperative wexner score, n (%)			0.031
< 10	15 (65.22)	51 (86.44)
≥ 10	8 (34.78)	8 (13.56)

RVF: Rectovaginal fistula.

Table 4 Multivariate analysis of risk factors for fistula recurrence

Variable	Multivariate analysis	P value
	HR (95%CI)
Previous repair history ≥ 1	-	0.053
Stoma	-	0.159
Diameter of fistula ≥ 0.5 cm	-	0.369
Conventional suture repair	3.838 (1.502-9.807)	0.005
Preoperative Wexner score ≥ 10	2.696 (1.131-6.427)	0.025

CI: Confidence interval; HR: Hazard ratio.