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Martius flaps for low rectovaginal fistulae: a systematic review and proportional meta-analysis
Daisy Swindon1, Sara Izwan1, Justin Ng1
1Department of Colorectal Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Background:
Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various others, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition.
Methods:
A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, whilst secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible.
Results:
Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF were included. The mean age of the study population was 42.4 (±15.7), years. There were 44 primary and 93 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45-98.46; I2 = 32.1%; P = 0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24-89.67; I2 = 58.1%; P = 0.008). The weighted mean complication rate was 29% (95% CI: 8.98-54.68; I2 = 85.4%; P < 0.0001) and the overall recurrence rate was 12.0% (95% CI: 5.03-21.93; I2 = 52.3%; P = 0.021). When purely radiotherapy-induced RVF were evaluated, the mean overall success rate was 94.6% (95% CI: 83.33-99.75; I2 = 0%; P = 0.350).
Conclusions:
MF interposition appears to be more effective for primary than recurrent RVF. However, the poor quality of the data limits definitive conclusions being drawn and demands further assessment with randomized studies.
Insights
The Martius flap (MF) shows higher success rates for primary rectovaginal fistulae (RVF) than recurrent ones. However, more randomized studies are needed to confirm these findings due to data limitations.
Area of Science:
- Surgical techniques
- Gastroenterology
- Gynecologic surgery
Background:
- Rectovaginal fistulae (RVF) present significant treatment challenges.
- The Martius flap (MF) is one surgical option for RVF management, but its universal success is not established.
Purpose of the Study:
- To assess the outcomes of rectovaginal fistulae managed with Martius flap interposition.
- To determine the mean success rate, complication rate, and recurrence rate of MF for RVF.
Main Methods:
- A PRISMA-compliant meta-analysis was conducted on studies reporting MF outcomes for RVF.
- Proportional meta-analyses were performed using MedCalc software.
- Weighted mean values and 95% confidence intervals were calculated and stratified by etiology.
Main Results:
- Twelve non-randomized studies involving 137 Martius flaps were analyzed.
- The weighted mean success rate was 91.4% for primary RVF and 77.5% for recurrent RVF.
- The overall complication rate was 29% and the recurrence rate was 12.0%.
Conclusions:
- Martius flap interposition demonstrates higher efficacy in treating primary RVF compared to recurrent RVF.
- The current evidence is limited by data quality, necessitating further investigation with randomized controlled trials.
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