Rectovaginal Fistulas: Current Surgical Management

ABSTRACT

Rectovaginal fistulas represent an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. Etiologies include obstetrical trauma, inflammatory bowel disease, malignant processes, and complications of radiation therapy and surgery. Repair options include local repairs, tissue transfer techniques, and abdominal operations.

KEYWORDS

Fistula - rectovaginal - obstetrical trauma - mucosal advancement flap

REFERENCES

• 1 Fenner D E, Genberg B, Brahma P, Marek L, DeLancey J O. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States.  Am J Obstet Gynecol. 2003;  189 1543-1549
• 2 Signorello L B, Harlow B L, Chekos A K, Repke J T. Midline episiotomy and anal incontinence: retrospective cohort study.  BMJ. 2000;  320 86-90
• 3 Christianson L M, Bovbjerg V E, McDavitt E C, Hullfish K L. Risk factors for perineal injury during delivery.  Am J Obstet Gynecol. 2003;  189 255-260
• 4 Hudelist G, Gelle'n J, Singer C et al.. Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy.  Am J Obstet Gynecol. 2005;  192 875-881
• 5 Venkatesh K S, Ramanujam P S, Larson D M, Haywood M A. Anorectal complications of vaginal delivery.  Dis Colon Rectum. 1989;  32 1039-1041
• 6 Goldaber K G, Wendel P J, McIntire D D, Wendel Jr G D. Post-partum perineal morbidity after fourth degree perineal repair.  Am J Obstet Gynecol. 1993;  168 489-493
• 7 Radcliffe A G, Ritchie J K, Hawley P R, Lennard-Jones J E, Northover J M. Anovaginal and rectovaginal fistulas in Crohn's disease.  Dis Colon Rectum. 1988;  31 94-99
• 8 Schwartz D, Loftus E, Tremaine W et al.. The natural history of fistulizing Crohn's disease: a population based study.  Gastroenterology. 2000;  118 A337
• 9 Kodner I J, Mazor A, Shemesh E I, Fry R D, Fleshman J W, Birnbaum E H. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas.  Surgery. 1993;  114 682-689
• 10 Ozuner G, Hull T L, Cartmill J, Fazio V W. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas.  Dis Colon Rectum. 1996;  39 10-14
• 11 Sonoda T, Hull T, Piedmonte M R, Fazio V W. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap.  Dis Colon Rectum. 2002;  45 1622-1628
• 12 Lowry A C, Thorson A G, Rothenberger D A, Goldberg S M. Repair of simple rectovaginal fistulas. Influence of previous repairs.  Dis Colon Rectum. 1988;  31 676-678
• 13 Tsang C B, Madoff R D, Wong W D et al.. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair.  Dis Colon Rectum. 1998;  41 1141-1146
• 14 Khanduja K S, Padmanabhan A, Kerner B A, Wise W E, Aguilar P S. Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty.  Dis Colon Rectum. 1999;  42 1432-1437
• 15 Hull T L, Fazio V W. Surgical approaches to low anovaginal fistula in Crohn's disease.  Am J Surg. 1997;  173 95-98
• 16 Marchesa P, Hull T L, Fazio V W. Advancement sleeve flaps for treatment of severe perianal Crohn's disease.  Br J Surg. 1998;  85 1695-1698
• 17 Mazier W P, Senagore A J, Schiesel E C. Operative repair of anovaginal and rectovaginal fistulas.  Dis Colon Rectum. 1995;  38 4-6
• 18 Cintron J R, Park J J, Orsay C P et al.. Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up.  Dis Colon Rectum. 2000;  43 944-949 discussion 949-950
• 19 Champagne B J, O'Connor L M, Ferguson M, Orangio G R, Schertzer M E, Armstrong D N. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up.  Dis Colon Rectum. 2006;  49 1817-1821
• 20 Abel M E, Chiu Y S, Russell T R, Volpe P A. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas.  Dis Colon Rectum. 1993;  36 447-449
• 21 Loungnarath R, Dietz D W, Mutch M G, Birnbaum E H, Kodner I J, Fleshman J W. Fibrin glue treatment of complex anal fistulas has low success rate.  Dis Colon Rectum. 2004;  47 432-436
• 22 Rahman M S, Al-Suleiman S A, El-Yahia A R, Rahman J. Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years' experience in a teaching hospital.  J Obstet Gynaecol. 2003;  23 607-610
• 23 Bauer J J, Sher M E, Jaffin H, Present D, Gelerent I. Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease.  Ann Surg. 1991;  213 151-158
• 24 Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner J M, Rabau M. Gracilis muscle transposition for fistulas between the rectum and urethra or vagina.  Dis Colon Rectum. 2006;  49 1316-1321
• 25 Tran K T, Kuijpers H C, van Nieuwenhoven E J, van Goor H, Spauwen P H. Transposition of the rectus abdominis muscle for complicated pouch and rectal fistulas.  Dis Colon Rectum. 1999;  42 486-489
• 26 Horch R E, Gitsch G, Schultze-Seemann W. Bilateral pedicled myocutaneous vertical rectus abdominis muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds.  Urology. 2002;  60 502-507
• 27 White A J, Buchsbaum H J, Blythe J G, Lifshitz S. Use of the bulbocavernosus muscle (Martius procedure) for repair of radiation-induced rectovaginal fistulas.  Obstet Gynecol. 1982;  60 114-118
• 28 Aartsen E J, Sindram I S. Repair of the radiation induced rectovaginal fistulas without or with interposition of the bulbocavernosus muscle (Martius procedure).  Eur J Surg Oncol. 1988;  14 171-177
• 29 Parks A G, Allen C L, Frank J D, McPartlin J F. A method of treating post-irradiation rectovaginal fistulas.  Br J Surg. 1978;  65 417-421
• 30 Nowacki M P. Ten years of experience with Parks' coloanal sleeve anastomosis for the treatment of post-irradiation rectovaginal fistula.  Eur J Surg Oncol. 1991;  17 563-566
• 31 Cooke S A, Wellsted M D. The radiation-damaged rectum: resection with coloanal anastomosis using the endoanal technique.  World J Surg. 1986;  10 220-227
• 32 Bricker E M, Johnston W D. Repair of postirradiation rectovaginal fistula and stricture.  Surg Gynecol Obstet. 1979;  148 499-506
• 33 Steichen F M, Barber H K, Loubeau J M, Iraci J C. Bricker-Johnston sigmoid colon graft for repair of postradiation rectovaginal fistula and stricture performed with mechanical sutures.  Dis Colon Rectum. 1992;  35 599-603
• 34 Schwenk W, Bohm B, Grundel K, Muller J. Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty.  Surg Endosc. 1997;  11 147-149
• 35 Pelosi III M A, Pelosi M A. Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization.  J Laparoendosc Adv Surg Tech A. 1997;  7 379-383
• 36 Kumaran S S, Palanivelu C, Kavalakat A J, Parthasarathi R, Neelayathatchi M. Laparoscopic repair of high rectovaginal fistula: is it technically feasible?.  BMC Surg. 2005;  5 20