Repair of simple rectovaginal fistulas

Abstract

The results of 81 endorectal flap advancements for simple rectovaginal fistulas are reported. Simple fistulas are defined as less than 2.5 cm in diameter, low or mid vaginal septum in location, and infectious or traumatic in origin. Essentially, the technique is advancement of a flap of mucosa, submucosa, and circular muscle over midline approximation of internal sphincter muscle. The mean patient age was 34 years old (range, 18 to 76 years). The causes were obstetrical injury (74 percent), perineal infection (10 percent), operative trauma (7 percent), and unknown (8 percent). Overall, the repair was successful in 83 percent of patients. Success correlated with the number of previous repairs, i.e., none: 88 percent success; one: 85 percent success; two: 55 percent success. There were 25 concomitant overlapping sphincteroplasty procedures. Only minor complications ensued, with no mortality. This repair is recommended for patients with no or one previous repair because of its lack of mortality, minimal morbidity, ease of concomitant sphincteroplasty, and avoidance of a colostomy. For patients with two or more earlier repairs, a muscle interposition should be considered.

Complex Rectovaginal Fistula—an Experience at a Tertiary Care Centre

“…The most common cause of rectovaginal fistulae in developing countries is obstetric injury, and this has been reported occurring in up to 88 % of patients in published series [5][6][7]. Prolonged labour, causing necrosis of the rectovaginal septum, leads to the formation of a fistula.…”

“…A waiting period of 3 to 6 months has been suggested by Lowry et al [7] before attempted repair so that there is a resolution of infection. Hibbard [6] opined that a waiting period of 3 months was probably sufficient.…”

“…MacRae and colleagues [3] retrospectively reviewed 28 patients who had had at least one previous attempt at repair with an overall success rate of 61 % (17 out of 28). Lowry et al [7] reported an overall successful repair rate of 83-88 % in patients undergoing a primary repair, 85 % after one previous failed attempt and 55 % after two prior failed repairs. Halverson et al [4] reported a 79 % success rate after a median Table 4.…”

“…Although no correlation between method of initial repair and success of further repairs was found in our study, out of 10 recurrent fistulae in our series, 9 underwent reinforcement with muscle or omental flaps with no recurrence. Lowry et al [7] also suggested that in patients with two or more previous repairs, muscle interposition should be considered. Regardless of the type of repair, certain principles, such as gentle handling, careful debridement and adequate mobilisation of tissue to allow tension-free approximation, are essential for a successful outcome [4].…”

Repair of recurrent rectovaginal fistula after low anterior resection with martius flap technique: report of a case

“…4,7 Primary repair of rectovaginal fistulas are associated with a success rate of 70 to 97%. 1,8,10 The reported outcome is worse, 40 to 85%, when patients are undergoing rectovaginal fistula repair after one or more prior repairs have failed. 6,8,10 The success of repair of RRVFs depends upon the health of the tissue, keeping in mind that it has been seriously effected by the underlying etiology and failed operations, and may therefore not heal.…”