Minimally invasive endoscopic repair of rectovaginal fistula

Table 1 Extract data of studies included

Number	Ref.	Type of study and evidence level	No. of patient(s)	Age of patients (yr)	Fistula etiology	Fistula type	No. of patients with previous repair	Diversion stoma	Life quality assessment (yes or no)
1	D'Ambrosio et al[41], 2012	Retrospective, level IV	13	44 (range, 25-70)	Surgery (n = 12); Radiation (n = 1)	Mid-low	13	Yes, 13 patients	No
2	Lamazza et al[54], 2016	Retrospective, level IV	15	58 (rang, 36-77)	Surgery with radiation (n = 15)	Mid-low	4	Yes, 4 patients	No
3	van Vledder et al[56], 2016	Retrospective, level IV	5	40 (range, 35-73)	Surgery (n = 5)	Mid-low	0	Yes, 3 patients	No
4	Yuan et al[42], 2019	Retrospective, level IV	17	46 (range, 10-76)	Surgery (n = 11); Congenital (n = 3); Obstetric (n = 2); IBDs (n = 1)	Mid-low	6	Yes, 9 patients	No
5	Tong et al[50], 2019	Prospective, level IV	16	40.1 (range, 27-56)	Surgery with radiation (n = 6); Obstetric (n = 5); IBDs (n = 3); Unclear (n = 2)	Mid-low	13	Yes, 11 patients	No
6	Shibata et al[57], 1999	Case report, level IV	1	71	Surgery	Low	0	No	No
7	Darwood et al[58], 2008	Case report, level IV	1	71	Surgery with radiation (n = 1)	Unclear	0	Yes	No
8	John et al[45], 2008	Case report, level IV	1	77	Infection (n = 1)	Mid	0	No	No
9	Vavra et al[59], 2009	Case report, level IV	1	53	Trauma (n = 1)	Mid	0	Yes	Yes
10	Chen et al[43], 2016	Case report, level IV	1	22	Trauma (n = 1)	Mid	2	Yes	No
11	Matano et al[48], 2019	Case report, level IV	1	71	Surgery (n = 1)	Mid	Multiple times	Yes	No

Table 2 Details and results of the endoscopic repair approaches for rectovaginal fistulas

Number	Endoscopic repair	Operative time (min) and hospital-stay (d)	Follow-up (mo)	Resultsa	Complication
1	TEMS + fistulectomy + suturing (n = 13)	130 min (range, 90-150 min); 5 d (range, 3-8 d)	25	93% closed	Hematoma of the septum (n = 1); Abscess of the septum (n = 1); Moderate sphincter hypotonia (n = 1)
2	Endoscopic stenting (n = 15)	Unclear; Unclear	22 (range, 4-39)	80% closed	Pain (n = 1); Too uncomfortable to tolerate the stent (n = 1)
3	TEMS + fistulectomy + suturing (n = 4); TEMS + RAF (n = 1)	Unclear; Unclear	5 (range, 1-68)	40% closed	No complication
4	TEMS + VAF (n = 6); TEMS exploration + VAF (n = 6); TEMS + transvaginal suturing (n = 3); TES exploration + transvaginal suturing (n = 2)	75 min (range, 60-120 min); 8.29 d (range, 2-24 d)	8 (range, 2-24)	82.4% closed	No complication
5	OTSCs (n = 16)	Unclear; Unclear	10.2 (range, 8-36)	43.7% closed	Pain (n = 4); Spontaneous clip detachment (n = 1)
6	Endoscopic injection of fibrin glue (n = 1)	Few min; 0 d	12	Closed successfully	No complication
7	TEMS + RAF (n = 1)	Unclear; 2 d	6	Closed successfully	No complication
8	TTSCs (n = 1)	Unclear; Unclear	12	Closed successfully	Minimal flatus from vaginal (n = 1)
9	TEMS + suturing (n = 1)	125 min; 7d	12	Closed successfully	No complication
10	TEMS + stratified suturing (n = 1)	40 min; 2 d	12	Closed successfully	No complication
11	TTSCs (n = 1)	Unclear; Unclear	13	Closed successfully	No complication

^aSuccess rate (%) for retrospective or prospective studies, closed successfully or unsuccessfully for case reports.

TEMS: Transanal endoscopic microsurgery; OTSC: Over-the-scope clip; TTSC: Through-the-scope clip; RAF: Rectal advancement flap; VAF: Vaginal advancement flap.