Abstract: PD38-12
Sources of Funding: none

Introduction

Urorectal fistulation is an uncommon consequence of a number of problems but particularly after the treatment of prostate or rectal cancer. Where there is little doubt that post-surgical fistulae can be repaired with satisfactory results, the impact of radiotherapy on the outcome of fistula repair is controversial. Herein we review our experience.

Methods

We have repaired 127 urorectal fistulae in the last 10 years with a minimum of one year of follow-up. 24 patients have died or have been lost to follow-up leaving 41 patients who had an abdomino-perineal repair and 62 patients who had a transperineal repair - 103 patients in all. _x000D_ _x000D_ Of the 41 patients having an abdomino-perineal repair, 37 (90%) had had radiotherapy, or the combination of radiotherapy and surgery. Only 4 (10%) patients had a surgical cause of their fistula (NB these patients do not include patients with vesico-colic fistulae or other intra-abdominal fistulae). In the transperineal group 18 had had previous radiotherapy (29%) and the remaining 44 were purely post-surgical fistulae (71%). The principle implication for an abdomino-perineal repair is to deal with sepsis in the pre-sacral space or to deal with radiotherapy problems affecting the bladder or otherwise for omental wrapping of any repair._x000D_

Results

After a tansperineal repair there were 5 failures in each of the two groups. All 10 failures underwent an abdomino-perineal repair subsequently with a satisfactory outcome in 4 out of 5 in each group. The overall success rate of transperineal repair, therefore, is in excess of 95%. _x000D_ After abdomino-perineal repair the success rate in both groups was in excess of 90% in both the surgical and the irradiation group. _x000D_

Conclusions

91% of patients with post-surgical fistulae can be treated by transperineal surgery with a 98% success rate. Only 31% of post-irradiation patients can be treated transperineally. The other 69% will require an abdomino-perineal repair and both approaches are only suitable in carefully selected patients, although the results are satisfactory in 95%. Although the overall success rate is satisfactory, the postoperative morbidity of post-irradiation patients undergoing abdomino-perineal surgery is high (62%), the recovery is protracted and the return to functional normality prolonged.

Funding

none