LUSSY score predictive of failure of surgical closure of obstetric rectovaginal fistula in the Democratic Republic of the Congo

2025-03-12 | Télécharger

BACKGROUND :

Rectovaginal fistula (RVF) is a medical condition that is characterized by abnormal communication between the rectum and vagina, resulting in bothersome symptoms such as uncontrolled passage of gas and/or feces through the vagina. Patients who have this type of fistula may also have dyschezia, dyspareunia, localized pain, especially in the initial phase due to tissue inflammation or a feeling of pelvic or perineal heaviness.

Rectovaginal fistula (RVF) is a complex debilitating condition that results from several etiologies, obstetric trauma being the most common. Occasionally RVF closure is non-successful. The objective of this study is to develop a predictive score to identify predictors of failure of surgical closure of obstetric RVF (FSCORVF) in the Democratic Republic of the Congo.

This was an analytical cross-sectional study conducted on 268 patients with obstetric RVF who have received surgical management. We proceeded with a bivariate and then multivariate analysis. Score discrimination was assessed using the ROC curve and C-index and score calibration was done according to the Hosmer–Lemeshow test.

This study identified predictive factors for FSCORVF in the DRC, grouped in the LUSSY score. Complex fistulas (fistula size > 3 cm, severe fibrosis, combined fistulas) require advanced surgical routes different from the trans- vaginal and the transperineal ones used in the present study. Prevention of intraoperative hemorrhage and postop- erative infections requires rigorous preparation, appropriate antibiotic prophylaxis, and strict postoperative follow-up.