Transverse Transperineal Repair of Rectovaginal Fistulas in the Lower Vagina

The long‐term outcome of transvaginal anterior levatorplasty for intractable rectovaginal fistula

“…A study of gluteal-fold flap repair reported success in all four patients treated [8], but this involves more extensive surgery. The procedure described in the present study is similar to previous reports of transvaginal or transverse transperineal repair or puborectal sling interposition [5,9,15,26] in that the levator ani is transposed between the rectal and vaginal wall. This has the advantage of placing healthy well vascularized tissue in the rectovaginal septum [5].…”

“…The diameter of the fistula is classified as small (< 0.5 cm), medium (0.5-2.5 cm) and large (> 2.5 cm) [13]. Many reports of rectovaginal fistula repair include those that are small or low or of unknown size [1,5,9,[15][16][17][18]. A simple fistula is defined as one having a diameter of less than 2.5 cm lying at the level of the introitus or mid vagina and being infective or traumatic in origin [6].…”

“…This has the advantage of placing healthy well vascularized tissue in the rectovaginal septum [5]. The initial reported success rates of such procedures were between 92 and 100% [9,15,26], but a lower rate of 31% was reported in patients who had had a previous repair [5]. Wiskind et al [15] used a transverse transperineal approach to the levator ani muscles and Bauer et al used a transvaginal approach with an incision in the posterior vaginal wall around the introitus [9].…”

“…The initial reported success rates of such procedures were between 92 and 100% [9,15,26], but a lower rate of 31% was reported in patients who had had a previous repair [5]. Wiskind et al [15] used a transverse transperineal approach to the levator ani muscles and Bauer et al used a transvaginal approach with an incision in the posterior vaginal wall around the introitus [9]. Oom et al [5] applied both a transperineal approach and an approach through the posterior vaginal fourchette and commented that the reason for changing from a transperineal approach to a posterior vaginal fourchette incision was due to the high incidence of wound complications after the former.…”

Five‐layer Repair of Rectovaginal Fistula using a Vaginal Approach. A Case Report

“…Operative selection should be based o n the classification of the RVF (simple or complex) and an assessment of sphincteric function. Simple RVF are amenable to local procedures (1 1) which includes transanal, perineal and vaginal approaches with success rates approaching 70-90% (12).…”