Rectovaginal Fistula

Abstract

Our study suggested that aggressive surgical treatment of RVF, including early use of temporary stoma and major procedure in case of failure of previous local treatment, leads to high success rates.

Internal Pudendal Artery Perforator Island Flap for Management of Recurrent Benign Rectovaginal Fistula

“…3 Despite the high failure rates reported whatever the surgical option chosen, few studies have reported to date an algorithm for the step-up management of RVF. 4 This has ranged from simple seton drainage, fibrin glue, plug insertion, advancement mucosal flaps, sphincteroplasty, biomesh interposition to more complex procedures such as gracilis or Martius muscle interposition or abdominal procedures. 3–5 The value of the defunctioning stoma in the surgical management of RVF is still debatable; however, it has been reported to improve outcomes in patients who have had a number of failed repairs.…”

Rectovaginal Fistulas Secondary to Obstetrical Injury

“…26 The literature largely consists of patient series in which different techniques are used for different groups of patients according to surgeon preference. 19,27,28 Smoking, 22 obesity, 23 and exposure to pelvic radiation 29 have been associated with significantly higher rates of recurrence.…”

“…Fibrin glue injection has definitive closure rates in the 10 to 15% range, and thus is typically reserved for patients who cannot tolerate more invasive procedures. 27 A pilot study of autologous fat graft injection to the fistula tract achieved tissue healing in 77% of women after an average of 1.8 procedures, although roughly one-third of their small sample was protected with a diverting stoma. 32 Bioprosthetic plugs have limited data to support their efficacy.…”

“…There are no randomized trials comparing closure rates with and without diversion and nonrandomized series suffer from significant selection bias. A small portion of patients, up to 15% in some studies, 27 will achieve RVF closure through diversion alone, making it hard to separate the impact of the surgical repair from that of the diversion. One small randomized trial of fecal diversion at the time of sphincteroplasty for FI found no functional advantage to diversion.…”

“…Incontinence scores improved equally across both groups and there was no difference in overall complications. 70 One large study combining a variety of RVF repairs did find a higher closure rate among patients with a stoma (88-45%), 27 although the majority of the literature found no benefit to stoma formation. 22,23,41,67,68 The decision to perform a diverting stoma, therefore, remains surgeon specific.…”