Abstract
Background
Treatment of benign rectovaginal fistula has a high failure rate and entails difficult decisions. The purpose of this retrospective study was to clarify the concepts which may improve its management.
Methods
Between 1983 and 2004, 46 consecutive women of median age 41 years were treated by the same surgeon. Etiology of simple fistulas was iatrogenic (n=6), obstetric (n=4) and septic (n=3). Complex fistulas were due to inflammatory bowel diseases (IBD) (n=18, 11 pouchvaginal) or were iatrogenic (n=9), actinic (n=5) or septic (n=1). Surgical techniques included endorectal or vaginal advancement flaps, fistulectomy and sphincteroplasty, vaginal/rectal closure and epiploplasty, restorative proctectomy and restorative proctocolectomy. In 20 patients, a diverting stoma was performed as a single procedure or concomitant to the curative attempt.
Results
Overall, 33 of the 39 fistulas (85%) treated for cure healed, including all simple fistulas and 20 complex fistulas (8 iatrogenic, 3 actinic, 2 ulcerative colitis without restorative proctocolectomy; 5 pouch vaginal; 1 septic; 1 Crohn’s disease) (p=0.009). The first operation for the fistula was curative in 20 of 39 fistulas, including 10 of 13 simple and 10 of 26 complex fistulas (p=0.023). There was no significant age difference between cured and not-cured patients.
Conclusions
Simple versus complex fistulas is the most determinant factor for healing. In IBD fistulas, ulcerative colitis shows better prognosis than Crohn’s disease. For complex fistulas, a temporary diverting stoma seems necessary.
Similar content being viewed by others
References
-(2005) Enfermedad anorrectal benigna. Cir Esp 78[Suppl 3]:1-11
Lowry AC, Thorson G, Rothenberger DA, Goldberg SA (1988) Repair of simple rectovaginal fistulas: influence of previous repairs. Dis Colon Rectum 31:676–678
Rothenberger DA, Christenson CE, Balcos EG et al (1982) Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum 25:297–230
Parks AG, Allen CLO, Frank JD et al (1978) Amethod of treating post-irradiation rectovaginal fistulas. Br J Surg 65:417–421
Utsunomiya J, Iwama T, Imajo M et al (1980) Total colectomy, mucosal proctectomy and ileoanal anastomosis. Dis Colon Rectum 23:459–466
Wise WE Jr, Aguilar PS, Padmanabhan A et al (1991) Surgical treatment of low rectovaginal fistulas. Dis Colon Rectum 34:271–274
Zimmerman DDE, Gosselink MP, Briel JW, Schouten WR (2002) The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition. Tech Coloproctol 6:37–42
Oom DMJ, Gosselink MP, Van Dijl VRM, Zimmerman DDE, Schouten WR (2006) Puborectal sling interposition for the treatment of rectovaginal fistulas. Tech Coloproctol 10:125–130
Watson SJ, Phillips RKS (1995) Non-inflammatory rectovaginal. Br J Surg 82:1641–1643
MacRae HM, MacLeod RS, Cohen Z (1995) Treatment of rectovaginal fistula that has failed previous repair attempts. Dis Colon Rectum 38:921–925
Parkash S, Lakshmiratan V, Gajendran V (1985) Fistula-inano: treatment by fistulectomy, primary closure and reconstitution. Aust N Z J Surg 55:23–27
Perez F, Arroyo A, Serrano P, Candela F, Sanchez A, Calpena R (2005) Fistulotomy with primary sphincter reconstruction in the management of complex fistula-in-ano: prospective study of clinical and manometric results. J Am Coll Surg 200:897–903
Tsang CB, Madoff RD, Wong WD et al (1998) Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 41:1141–1146
Gorenstein L, Boyd JB, Ross TM (1988) Gracilis muscle repair of rectovaginal fistula after restorative proctocolectomy: report of two cases. Dis Colon Rectum 31:730–734
Onodera H, Nagayama S, Kohmoto I, Maetani S, Imamura M (2003) Novel surgical repair with bilateral gluteus muscle patching for intractable rectovaginal fistula. Tech Coloproctol 7:198–202
Pye PK, Dada T, Duthie G, Phillips K (2004) Surgisis mesh: a novel approach to repair of a recurrent rectovaginal fistula. Dis Colon Rectum 47:1554–1556
Haray PN, Stiff G, Foster ME (1996) New option for recurrent rectovaginal fistulas. Dis Colon Rectum 39:463–464
Miklos JR, Kohli N (1999) Rectovaginal fistula repair utilizing a cadaveric dermal allograft. Int Urogynecol J 10:405–406
Chitrathara K, Namratha D, Francis V, Gangadharan VP (2001) Spontaneous rectovaginal fistula and repair using bulbocavernosus muscle. Tech Coloproctol 5:47–49
Sher MA, Bauer JJ, Gelernt I (1991) Surgical repair of rectovaginal fistulas in patients with Crohn’s disease: transvaginal approach. Dis Colon Rectum 34:641–648
Simmang CL, Lacey SW, Huber PJ Jr (1998) Rectal sleeve advancement repair of rectovaginal fistula associated with anorectal stricture in Crohn’s disease. Dis Colon Rectum 41:787–789
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Devesa, J.M., Devesa, M., Velasco, G.R. et al. Benign rectovaginal fistulas: management and results of a personal series. Tech Coloproctol 11, 128–134 (2007). https://doi.org/10.1007/s10151-007-0342-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-007-0342-1