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World J Gastrointest Surg. Aug 27, 2015; 7(8): 133-137
Published online Aug 27, 2015. doi: 10.4240/wjgs.v7.i8.133
Operative considerations for rectovaginal fistulas
Kevin R Kniery, Eric K Johnson, Scott R Steele
Kevin R Kniery, Eric K Johnson, Scott R Steele, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, Tacoma, WA 98431, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: The authors do not have any conflicts-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kevin R Kniery, MD, General Surgery Resident, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, United States. krkniery@gmail.com
Telephone: +1-504-6554276
Received: April 29, 2015
Peer-review started: April 29, 2015
First decision: May 14, 2015
Revised: May 26, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 27, 2015
Processing time: 125 Days and 5.1 Hours
Abstract

To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches 40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas.

Keywords: Rectovaginal fistulas; Anovaginal fistulas

Core tip: There are general principles that will allow the best chance for resolution of a rectovaginal fistula with the least morbidity to the patient. Identifying and addressing the disease process that caused the fistula is critical, including medical management for Crohn’s, and resolving inflammation or sepsis with a seton. Then the exact anatomy of the fistula should be defined to determine operative approaches. The operative algorithm should begin with fistula plugs and local advancement flaps, if these fail more invasive options such as diversion, and interposition of healthy tissue should be pursued for complex and recurrent fistulas.