Avaliação por ressonância magnética das alterações radiológicas em pacientes com fístula retovaginal ou anovaginal tratadas com laser fracionado de CO2 intravaginal

Abstract

Introduction: Anovaginal (AVF) and rectovaginal (RVF) fistulas are abnormal tracts that connect the lower gastrointestinal tract to the vagina. Women suffering from this condition mainly experience spontaneous passage of gas and faeces through the vagina. Despite advances in surgical and clinical treatment, there is no consensus on the best therapeutic approach. Faced with this challenging scenario, fractionated CO2 laser is gaining prominence as a possible form of auxiliary treatment and magnetic resonance imaging (MRI) of the pelvis as a good diagnostic resource and for evaluating the effectiveness of therapy. Objectives: To assess the radiological changes seen on MRI of the pelvis before and after laser treatment, as well as the effectiveness and safety of this therapy for the treatment of AVF and AVF. Materials and Methods: This was a prospective, open, single-centre study in which 15 patients were recruited from the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were the presence of clinically suspected AVF or AVF of any aetiology, confirmed by MRI of the pelvis and gynaecological examination. Before and after 6 months of treatment, all patients underwent five fractionated CO2 laser sessions, at monthly intervals, followed by a full assessment through clinical examination and MRI. Results: 10 patients (67.7%) had complete resolution of symptoms, while the others (32.3%) reported significant improvement. Three of the four ostomised patients were reanastomised and remain complaint-free. All six patients with Crohn's disease reported significant improvement in symptoms and sexual activity after therapy. In seven (47%) patients, radiological remission of the fistula was confirmed by MRI and in the remaining eight (53%) radiological improvement was observed. Conclusion: MRI of the pelvis should be considered a good diagnostic resource, for evaluating therapy and for following up patients treated with vaginal fractionated CO2 laser. The CO2 laser can be considered a promising and safe complementary therapeutic alternative for the management of AVFs and VFRs.