Ileoanal pouch vaginal fistula (PVF) is a relatively common complication of restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA). There are several operative approaches in the management of PVF. There is currently no consensus as to which approach is the most effective or which should be attempted first.
A systematic review was undertaken following a publicly available protocol registered with PROSPERO (CRD42019133750) in accordance with PRISMA Guidelines. Online searches of databases Medline and Embase, Cochrane Library, ClinicalTrials.gov, EU Clinical Trials, ISRCTN registry were performed.
27 articles met the criteria for inclusion in the study: 13 retrospective cohort studies, 2 prospective cohort studies, 8 case series, 3 case reports and a case-control study. A narrative synthesis was performed due to heterogeneity between included articles. Our study included 577 PVFs, the incidence rate was 2.1-17.1%. Both local and abdominal approaches were used in the management of PVF. The overall success of local and abdominal procedures was 44.9% and 60.2% respectively. ROBINS-I assessment revealed a critical risk of bias. GRADE assessment indicated a very low certainty in effect size and evidence quality.
Local interventions and abdominal approaches have a high failure rate. The results of this review will aid the counselling of patients with this condition. Furthermore, we provide an algorithm for discussion on the management of PVF based on experience at our local centre. The studies available on management of PVF are low quality; a large prospective registry and Delphi consensus are required to further this area of research.
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