Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. A single-center...

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Bibliographic Details
Published in:BMC research notes Vol. 16; no. 1; p. 371
Main Authors: Drumond, Denise Gasparetti, Condé, Camila de Moraes Sarmento, Chebli, Júlio Maria da Fonseca, Chebli, Liliana Andrade, Esperança, Samuel Drumond, Speck, Neila Maria de Góis
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 19-12-2023
BioMed Central
BMC
Subjects:
Asymptomatic
Carbon Dioxide
Care and treatment
CO2 laser
Crohn's disease
Crohns disease
Development and progression
Etiology
Female
Females
Fistula
Follow-Up Studies
Gynecology
Health aspects
Humans
Inflammation
Inflammatory bowel diseases
Lasers
Lasers in medicine
Lasers in surgery
Magnetic resonance imaging
Obstetrics
Patients
Prospective Studies
Questionnaires
Rectovaginal fistula
Rectovaginal Fistula - diagnostic imaging
Rectovaginal Fistula - etiology
Rectovaginal Fistula - surgery
Remission
Remission (Medicine)
Research Note
Sexual disorders
Statistical analysis
Surgery
Treatment
Treatment Outcome
Vagina
Vagina - diagnostic imaging
Vagina - surgery
Womens health
Brazil
Rectovaginal fistula
CO2 laser
Treatment
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Summary:Despite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment. A single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment. The total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ). The evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn's disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI. CO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.
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ISSN:1756-0500
1756-0500
DOI:10.1186/s13104-023-06666-8