SURGICAL INTERVENTIONS IN THE TREATMENT OF RECTOVAGINAL FISTULAS IN PATIENTS WITH CROHN'S DISEASE: A MULTIDISCIPLINARY APPROACH IN GYNECOLOGY AND PLASTIC SURGERY

Abstract

Introduction: Rectovaginal fistulas in patients with Crohn's disease represent a challenging complication, affecting quality of life and requiring specialized surgical interventions. These fistulas, which connect the rectum to the vagina, are often the result of chronic inflammation, and are characterized by a high incidence in women. Effective management requires a multidisciplinary approach, involving gynecologists and plastic surgeons, in order to promote healing and restore functionality. The combination of surgical techniques and gynecological care can reduce recurrence rates and improve clinical outcomes. Objective: To analyze the existing literature on surgical interventions for rectovaginal fistulas in patients with Crohn's disease, focusing on the effectiveness of multidisciplinary approaches involving gynecology and plastic surgery. Methodology: The methodology followed the PRISMA checklist, using the PubMed, SciELO and Web of Science databases. Five descriptors were selected: "rectovaginal fistula", "Crohn's disease", "surgical intervention", "gynecology" and "plastic surgery". The search included articles published in the last 10 years. Inclusion criteria consisted of studies with patients diagnosed with Crohn's disease and rectovaginal fistulas, reported surgical interventions and articles in English, Portuguese or Spanish. Exclusion criteria included literature reviews, studies with less than 10 patients and articles that did not directly address surgical management. Results: The results indicated that surgical interventions, such as fistulectomy and tissue transposition techniques, were effective in resolving fistulas. Collaboration between gynecologists and plastic surgeons was essential to optimize results, demonstrating that the multidisciplinary approach allowed more effective management and a lower recurrence rate. In addition, consideration of individual patient characteristics and personalization of interventions were aspects highlighted in the literature. Conclusion: The analysis revealed that surgical interventions for the treatment of rectovaginal fistulas in patients with Crohn's disease benefit substantially from a multidisciplinary approach. The integration of gynecology and plastic surgery specialties not only improved clinical outcomes but also promoted a better quality of life for patients, highlighting the importance of a coordinated and comprehensive treatment.