Contemporary surgical management of rectovaginal fistula in Crohn's disease

Figure 1 Rectal advancement flap. The rectal advancement flap begins with a 180 degree curvilinear incision starting just distal to fistula opening and extends 4-5 cm cephalad, encompassing mucosa, submucosa and the rectal wall is dissected from the rectovaginal septum. After mobilization, the fistula tract is cored out and the opening is closed with absorbable sutures. The diseased distal portion of the flap is trimmed before and the flap is advanced distally and sutured to the cut edge with absorbable sutures. The vaginal or perineal external opening is left open for drainage. Reprinted with permission, Cleveland Clinic Center for Medical Art and Photography © 1999-2014. All Rights Reserved.