Background: The management of obstetric rectovaginal fistula (RVF) is challenging for the surgeon. The best surgical procedure to repair RVFs, specifically after obstetric anal sphincter injury, has not been extensively studied. The objective was to compare the success of the different procedures performed to repair obstetric RVF.

Methods: The literature search was carried out on PubMed^® and Web of Science^® from database inception until 31 December 2022. Selection criteria were: (1) patients with a diagnosis of obstetric-related RVF; (2) patients treated surgically with no restriction concerning the considered surgery; (3) clinical trials or epidemiological studies. Meta-analysis was conducted considering the network meta-analysis framework to allow studying the relative value of each treatment mentioned in the selected articles.

Results: The quantitative synthesis included 32 studies (18 retrospective and 14 prospective) accounting for 595 patients. The quality of these studies was low because of the lack of prospective randomization. Nineteen procedure types were described and assessed. Most patients (n = 180) underwent endorectal advancement flap (ERAF) followed by excision and layered closure (ELC) (n = 213) and Musset procedure (n = 65). A diverting stoma was performed in 66/132 patients. Only 13 studies reported the functional results of the procedure. In the meta-analysis, the Musset procedure (OR = 4.29; 95% CI: 1.18-16.14), transvaginal ELC (OR = 11.84; 95% CI: 2.18-91.80) and transperineal ELC (OR = 3.56; 95% CI: 1.26-10) significantly improved the anatomical results compared to ERAF.

Conclusions: A further randomized controlled trial in the literature assessing ERAF and sphincteroplasty to compare the anatomical results, functional results and morbidity of this treatment is needed.

Registration: PROSPERO CRD42023447875.

Keywords: Anovaginal fistula; Obstetric; Rectovaginal fistula; Repair.

© 2025. The Author(s).

背景： 产科直肠阴道瘘（RVF）的管理对外科医生来说是一个挑战。针对产科肛门括约肌损伤后修复RVF的最佳手术方法尚未得到充分研究。本研究旨在比较不同手术方法修复产科RVF的成功率。

方法： 文献检索在PubMed^®和Web of Science^®数据库从建库开始至2022年12月31日进行。选择标准为：（1）诊断为与产科相关的RVF的患者；（2）接受手术治疗，不限制考虑的手术类型；（3）临床试验或流行病学研究。采用网络荟萃分析框架进行元分析，以评估所选文章中提到的各种治疗方法的相对价值。

结果： 定量综合了32项研究（18项回顾性和14项前瞻性），共涉及595名患者。由于缺乏前瞻性的随机化设计，这些研究的质量较低。描述并评估了19种手术类型。大多数患者（n = 180）接受了内镜下直肠推进瓣（ERAF）手术，其次是切除和分层缝合（ELC，n = 213）以及Musset手术（n = 65）。在132名患者中，有66名进行了造口术。只有13项研究报告了手术的功能结果。在元分析中，Musset手术（OR = 4.29；95% CI：1.18-16.14），经阴道ELC（OR = 11.84；95% CI：2.18-91.80）和经会阴ELC（OR = 3.56；95% CI：1.26-10）显著改善了解剖学结果，优于ERAF。

结论： 需要进一步的随机对照试验来评估ERAF和括约肌成形术在比较该治疗的解剖学、功能结果以及并发症方面的效果。

注册信息： PROSPERO CRD42023447875.

关键词： 肛阴道瘘；产科；直肠阴道瘘；修复。