Simple rectovaginal fistulas

Abstract

In regard to the causes of simple rectovaginal fistulas (RVF) we examined the methods of diagnosis and the efficacy and outcome of surgical procedures. The study included all of our patients diagnosed with simple RVF between December 1988 and July 1998 (n = 19). Medical charts of these patients were reviewed regarding diagnostic investigations, operative procedure, outcome, and follow-up. The most common cause was obstetric trauma (n = 15, 79%) followed by infection (n = 4, 21%). Eight patients (42%) had undergone anal surgery prior to the development of RVF; two of these had undergone more than one procedure. Endoanal ultrasound was performed in 15 patients and identified the fistula in 11 (73%). A concomitant sphincter injury was visualized in 9 of 15 patients (60%). The most common initial operation performed was an endoanal advancement flap in 12 patients (63%). This operation was performed in combination with a sphincteroplasty in 4 patients, while 3 had sphincteroplasty alone. The mean hospital stay was 3 days (range 1-5). Postoperative morbidity was noted in 5 patients (26%) of and consisted of recurrent fistula and passage of gas per vagina. Surgery was successful in complete resolution of symptoms in 14 cases (74%). Two of the three recurrences were successfully repaired with a repeat endoanal advancement flap, and one is awaiting repair. The mean follow-up for the entire group was 35.8 months (range 6-84). Endoanal advancement flap should be the initial treatment of choice for simple, low rectovaginal fistulas. The procedure can also be employed with expectations of success even after a failed primary repair and should be combined with sphincteroplasty if a coexistent anteriorly based anal sphincter defect is noted either by clinical examination or endoanal ultrasonography.

Are There Predictors of Outcome Following Rectovaginal Fistula Repair?

“…[1][2][3][4][5][6][7] Inflammatory bowel disease, including mucosal ulcerative colitis and Crohn's disease, is another contributing cause of RVF with rates varying between 6% and 23%, 16 -18 although Crohn's disease is more commonly associated with RVF formation because of its transmural involvement of the bowel wall. This finding is supported by a study from Radcliffe et al 18 which identified 90 (9.8%) of 886 female patients with Crohn's disease involvement of the rectovaginal septum.…”

“…The most common acquired etiology is obstetric injury followed by inflammatory bowel disease and then infectious causes. [1][2][3][4][5][6][7] The diagnosis of a RVF is based on history and physical examination. However, in recurrent or refractory cases, further evaluation with endoanal ultrasound or pelvic magnetic resonance imaging may be required to better elucidate the anatomy.…”

“…The minimal contribution from the medical literature consists mostly of case reports and case series; the surgeon's best operative approach continues to be a challenging decision. [1][2][3][4][5][6][7] The aim of this study is to assess the results of RVF repair over a 20-year period, as performed by urogynecologists and colorectal surgeons, and to identify the factors associated with poor outcome.…”

Surgisis™ Mesh: A Novel Approach to Repair of a Recurrent Rectovaginal Fistula

“…1 The majority of RVF result from obstetric injury during prolonged labor in which the persistent pressure on the rectovaginal septum can lead to ischemia and necrosis. 2,3 Other causes include congenital anomalies, complications of gynecologic and colorectal surgery, inflammatory bowel disease, infection, irradiation injury, and carcinoma of the anus, rectum, and vagina. 4,5 Less common causes include venereal diseases, e.g., lymphogranuloma venereum, tuberculosis with perirectal abscesses and erosion of the rectovaginal septum by a foreign body (e.g., pessary).…”

Rectovaginal Fistula: A New Approach By Stapled Transanal Rectal Resection

“…5,6 Acquired RVF can be caused by infection, inflammation, tumor or trauma, and obstetric trauma is the undoubtedly most common trauma causing the lesion. 1,2,4,[7][8][9][10][11] We report a case of RVF that came to our observation and describe the patient tailored treatment adopted.…”