Rectovaginal Fistulas

ABSTRACT

Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. An individualized, systematic approach to these fistulas based on their size, location, and etiology provides a more concise treatment plan. Treatment options of medical therapy, advancement flaps, plugs, fistula ligation, and tissue interposition are discussed.

KEYWORDS

Rectovaginal fistula - advancement flap - fistulotomy

REFERENCES

• 1 Greenwald J C, Hoexter B. Repair of rectovaginal fistulas.  Surg Gynecol Obstet. 1978;  146(3) 443-445
• 2 Perez C A, Breaux S, Bedwinek J M et al.. Radiation therapy alone in the treatment of carcinoma of the uterine cervix. II. Analysis of complications.  Cancer. 1984;  54(2) 235-246
• 3 Boronow R C. Repair of the radiation-induced vaginal fistula utilizing the Martius technique.  World J Surg. 1986;  10(2) 237-248
• 4 de Dombal F T, Watts J M, Watkinson G, Goligher J C. Incidence and management of anorectal abscess, fistula and fissure, in patients with ulcerative colitis.  Dis Colon Rectum. 1966;  9(3) 201-206
• 5 Sher M E, Bauer J J, Gelernt I. Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach.  Dis Colon Rectum. 1991;  34(8) 641-648
• 6 Schwartz J, Rabinowitz H, Rozenfeld V, Leibovitz A, Stelian J, Habot B. Rectovaginal fistula associated with fecal impaction.  J Am Geriatr Soc. 1992;  40(6) 641
• 7 Hoffman M S, Wakeley K E, Cardosi R J. Risks of rigid dilation for a radiated vaginal cuff: two related rectovaginal fistulas.  Obstet Gynecol. 2003;  101(5 Pt 2) 1125-1126
• 8 Sharland M, Peake J, Davies E G. Pseudomonal rectovaginal abscesses in HIV infection.  Arch Dis Child. 1995;  72(3) 275
• 9 Parra J M, Kellogg N D. Repair of a recto-vaginal fistula as a result of sexual assault.  Semin Perioper Nurs. 1995;  4(2) 140-145
• 10 Corman M L. Rectovaginal fistulas. In: Colon and Rectal Surgery. 2 ed. Philadelphia; JB Lippincott Co. 1989
• 11 Bentley R J. Abdominal repair of high rectovaginal fistula.  J Obstet Gynecol Br Commonw. 80(4) 364-367
• 12 Daniels B T. Rectovaginal Fistula: A Clinical and Pathological Study [master's thesis]. Minneapolis; University of Minnesota Graduate School 1949
• 13 Rosenshein N B, Genadry R R, Woodruff J D. An anatomic classification of rectovaginal septal defects.  Am J Obstet Gynecol. 1980;  137 439-442
• 14 Stoker J, Rociu E, Schouten W R, Laméris J S. Anovaginal and rectovaginal fistulas: endoluminal sonography versus endoluminal MR imaging.  AJR Am J Roentgenol. 2002;  178(3) 737-741
• 15 Alexander A A, Liu J B, Merton D A, Nagle D A. Fecal incontinence: transvaginal US evaluation of anatomic causes.  Radiology. 1996;  199(2) 529-532
• 16 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(9) 1141-1146
• 17 Khanduja K S, Yamashita H J, Wise Jr W E, Aguilar P S, Hartmann R F. Delayed repair of obstetric injuries of the anorectum and vagina. A stratified surgical approach.  Dis Colon Rectum. 1994;  37(4) 344-349
• 18 Stoker J, Rociu E, Schouten W R, Laméris J S. Anovaginal and rectovaginal fistulas: endoluminal sonography versus endoluminal MR imaging.  AJR Am J Roentgenol. 2002;  178(3) 737-741
• 19 Stone J M, Goldberg S M. The endorectal advancement flap procedure.  Int J Colorectal Dis. 1990;  5(4) 232-235
• 20 Ellis C N. Outcomes after repair of rectovaginal fistulas using bioprosthetics.  Dis Colon Rectum. 2008;  51(7) 1084-1088
• 21 Van Koperen P J, Bemeiman W A, Bossuyt P M et al.. The anal fistula plug versus the mucosal advancement flap for the treatment of anorectal fistula (PLUG trial).  BMC Surg. 2008;  23(8) 11
• 22 Ky A J, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly E K. Collagen fistula plug for the treatment of anal fistulas.  Dis Colon Rectum. 2008;  51(6) 838-843
• 23 Gonsalves S, Sagar P, Lengyel J, Morrison C, Dunham R. Assessment of the efficacy of the rectovaginal button fistula plug for the treatment of ileal pouch-vaginal and rectovaginal fistulas.  Dis Colon Rectum. 2009;  52(11) 1877-1881
• 24 Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract.  J Med Assoc Thai. 2007;  90(3) 581-586
• 25 Bleier J I, Moloo H, Goldberg S M. Ligation of intersphincteric fistula tract: an effective technique for complex fistulae.  Dis Colon Rectum. 2010;  53(1) 43-46
• 26 Radcliffe A G, Ritchie J K, Hawley P R, Lennard-Jones J E, Northover J MA. Anovaginal and rectovaginal fistulas in Crohn's disease.  Dis Colon Rectum. 1988;  31(2) 94-99
• 27 Sher M E, Bauer J J, Gelernt I. Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach.  Dis Colon Rectum. 1991;  34(8) 641-648