PDF(Pubmed)
Abstract：
OBJECTIVE: Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.
METHODS: We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011-2023). Information about HIV management, surgical history, and long-term outcomes was collected.
RESULTS: Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1-3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5-55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3-25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05).
CONCLUSIONS: While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.
METHODS: We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011-2023). Information about HIV management, surgical history, and long-term outcomes was collected.
RESULTS: Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1-3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5-55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3-25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05).
CONCLUSIONS: While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.
摘要：
目的：获得性直肠阴道瘘（RVF）是儿科HIV感染的并发症。我们报告了这种情况的手术治疗经验。
方法：我们回顾性回顾了在ChrisHaniBaragwanath学术医院（2011-2023年）治疗的HIV相关RVF儿科患者的记录。关于艾滋病毒管理的信息，手术史,并收集了长期结果。
结果：确定了10名HIV相关性RVF患者。演示的中位年龄为2岁（IQR：1-3岁）。9名患者（9/10）接受了结肠造口术，而其中一个在造口成型之前就被淘汰了。结肠造口术后，瘘修复的中位数为17个月（IQR：7.5-55个月）。在5/9患者中插入了坐骨直肠脂肪垫。4例（4/9）患者瘘管复发，2/9患者出现肛门狭窄，和3/9会阴脓毒症。修复后中位16个月(IQR:3-25个月)进行造口逆转。七名患者（7/9）有良好的结果没有污染，而2/9有长期气孔。修复后未能维持病毒抑制与瘘复发和并发症显著相关(φ=0.8,p<0.05)。
结论：虽然与HIV相关的RVF仍然是一种具有挑战性的状况，成功的手术治疗是可能的。病毒抑制是良好结果的必要条件。
方法：我们回顾性回顾了在ChrisHaniBaragwanath学术医院（2011-2023年）治疗的HIV相关RVF儿科患者的记录。关于艾滋病毒管理的信息，手术史,并收集了长期结果。
结果：确定了10名HIV相关性RVF患者。演示的中位年龄为2岁（IQR：1-3岁）。9名患者（9/10）接受了结肠造口术，而其中一个在造口成型之前就被淘汰了。结肠造口术后，瘘修复的中位数为17个月（IQR：7.5-55个月）。在5/9患者中插入了坐骨直肠脂肪垫。4例（4/9）患者瘘管复发，2/9患者出现肛门狭窄，和3/9会阴脓毒症。修复后中位16个月(IQR:3-25个月)进行造口逆转。七名患者（7/9）有良好的结果没有污染，而2/9有长期气孔。修复后未能维持病毒抑制与瘘复发和并发症显著相关(φ=0.8,p<0.05)。
结论：虽然与HIV相关的RVF仍然是一种具有挑战性的状况，成功的手术治疗是可能的。病毒抑制是良好结果的必要条件。
