Musset's Surgical Technique: Evaluation of Long-term Results (LONGOMUSSET)
Condition: Rectovaginal Fistula; Obstetric Complication
MeSH terms: Rectovaginal Fistula; Fistula
Study type: Interventional

Summary: 
      The surgical technique of Musset has shown its effectiveness for the cure of recto-vaginal
      fistulas. Recto-vaginal fistulas are mostly post-obstetric (88%).

      The objective of this study is to investigate the outcome of patients who underwent a Musset
      surgical technique, as well as their postoperative functional and anatomical results at a
      distance from the procedure.
    

Detailed description: 
      Obstetric fistulas affect more than 2 million women worldwide with 50,000 to 100,000 cases
      per year and are responsible for symptoms that can alter the quality of life.

      Among fistulas, recto-vaginal fistulas are responsible for disabling symptoms such as the
      emission of gas and/or stool through the vagina, local infections with purulent and/or
      malodorous discharge from the vagina, and even dyspareunia. These disabling symptoms
      constitute a real psycho-social burden for the patients who suffer from them as demonstrated
      in the study of Singh et al. carried out in India where up to 79.5% felt socially isolated.
      In developing countries, women with fistula are often abandoned by their husbands and
      rejected by their families and communities.

      Recto-vaginal fistulas are mostly post-obstetric (88%). Indeed, in a study by Goldaber et al.
      of 24,000 vaginal births, an incidence of 1.7% of grade 4 tears and 0.5% of recto-vaginal
      fistulas was noted. However, recto-vaginal fistulas can be related to other causes: local
      infection, post-traumatic (violence, surgery), chronic inflammatory bowel disease (Crohn's
      ++), radiotherapy, carcinoma or congenital.

      The surgical technique of Musset, initially described in 1963, has shown its effectiveness
      for the cure of recto-vaginal fistulas. In Soriano's retrospective study, 48 patients had
      undergone recto-vaginal fistula repair using the Musset surgical technique: 25 of the
      fistulas were of obstetrical origin, 11 of infectious origin, 7 in the context of
      inflammatory bowel disease and 3 post-surgical. Of the 48 patients, 63% had a history of
      recto-vaginal fistula treatment, 85% had gas incontinence and 75% had stool incontinence. A
      total of 47 patients had a satisfactory anatomical and functional outcome with a success rate
      of 100% for post chronic inflammatory bowel disease fistulas and 98% for patients with a
      surgical history. Since then, the indication for this procedure has been extended to the
      treatment of obstetrical perineal sequelae with damage to the external sphincter. In this
      case, the procedure is usually done in one operation and not two as initially described.

      Although this condition affects a significant number of women (mainly in developing
      countries), few large studies have looked at the results of this technique and the literature
      is still relatively poor. In particular, no study has looked at the long-term and very
      long-term results of this surgical technique to definitively demonstrate its benefit, which
      is all the more fundamental as this pathology essentially affects young women.

      The objective of this study is to investigate the outcome of patients who underwent a Musset
      surgical technique, as well as their postoperative functional and anatomical results at a
      distance from the procedure.
    

Intervention name(s): surgical technique of Musset
Intervention type(s): Procedure
Intervention description(s): The one-stage rectovaginal fistula cure according to Musset is an intervention indicated in the treatment of simple post-obstetrical or simple post-surgical rectovaginal fistulas.
The procedure consists in performing a perineal section to the perineal section to the fistula pathway in order to perform local excision followed by a repair plane by plane with rectal and anal closure, then of the external sphincter of the anus, and interposition of the deep and superficial transverse elevator and perineal muscles before closing the vagina and perineum.
Intervention model: Single Group Assignment
Intervention model description: Descriptive study
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: surgical technique of Musset