Skip to main content

Treatment of rectovaginal fistulas that has failed previous repair attempts


PURPOSE: The purpose of this study was to assess results of treatment of rectovaginal fistulas (excluding pouch vaginal fistulas) that have failed previous attempts at repair. METHOD: A retrospective chart review of all patients presenting with nonhealing rectovaginal fistula was performed. RESULTS: Twenty eight patients with persistent fistulas were identified. In 18 patients the fistula was classified as simple, and in 10 the fistula was complex. Fourteen fistulas were secondary to obstetric injury, five were caused by Crohn's disease, and nine patients had miscellaneous etiologies for their fistulas. Of patients with persistent simple fistulas, 13 (72 percent) of the fistulas healed, 5 after advancement flaps, 5 following sphincteroplasty, and 3 after coloanal anastomoses. Of persistent complex fistulas, only four of ten (40 percent) healed, one following sphincteroplasty, one with coloanal anastomosis, and two after gracilis transposition. A total of 23 advancement flaps were done in 17 patients with five fistulas healing (29 percent). Sphincteroplasty and fistulectomy was successful in six of seven patients (86 percent). Coloanal anastomosis resulted in healing of four of six patients (67 percent) in whom it was attempted. Gracilis muscle transfer was successful in two of two patients (100 percent). CONCLUSION: Persistent rectovaginal fistula presents a difficult management problem. Choice of operation must be tailored to the underlying pathology and type of repair previously done. Advancement flap repair is generally not recommended for persistent complex fistulas or for simple fistulas that have failed a previous advancement flap repair.

This is a preview of subscription content, access via your institution.


  1. Lowry AC, Thorson AG, Rothenberger DA, Goldberg SA. Repair of simple rectovaginal fistulas: influence of previous repairs. Dis Colon Rectum 1988;31:676–8.

    PubMed  Google Scholar 

  2. Wise WE Jr, Aguilar PS, Padmanabhan A, Meesig DM, Arnold MW, Stewart WR. Surgical treatment of low rectovaginal fistulas. Dis Colon Rectum 1991;34:271–4.

    PubMed  Google Scholar 

  3. Hoexter B, Labow SB, Moseson MD. Transanal rectovaginal fistula repair. Dis Colon Rectum 1985;28:572–5.

    PubMed  Google Scholar 

  4. Nowacki MP, Szawlowski AW, Borkowski A. Parks' coloanal sleeve anastomosis for treatment of postirradiation rectovaginal fistula. Dis Colon Rectum 1986;29:817–20.

    PubMed  Google Scholar 

  5. Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM. Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 1988;31:94–9.

    PubMed  Google Scholar 

  6. Morrison JG, Gathright JB Jr, Ray JE, Ferrari BT, Hicks TC, Timmcke AE. Results of operation for rectovaginal fistula in Crohn's disease. Dis Colon Rectum 1989;32:497–9.

    PubMed  Google Scholar 

  7. Rothenberger DA, Christenson CE, Balcos EG,et al. Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum 1982;25:297–300.

    PubMed  Google Scholar 

  8. Gorenstein L, Boyd JB, Ross TM. Gracilis muscle repair of rectovaginal fistula after restorative proctocolectomy: report of two cases. Dis Colon Rectum 1988;31:730–4.

    PubMed  Google Scholar 

  9. Corman ML. Anal incontinence following obstetrical injury. Dis Colon Rectum 1985;28:86–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Additional information

Dr. MacRae was supported in part by the Wigston Foundation, Toronto, Ontario, Canada.

Read at the meeting of The American Society of Colon and Rectal Surgeons, in Montreal, Quebec, Canada, May 7 to 12, 1995.

About this article

Cite this article

MacRae, H.M., McLeod, R.S., Cohen, Z. et al. Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 38, 921–925 (1995).

Download citation

  • Issue Date:

  • DOI:

Key words

  • Rectovaginal fistula
  • Advancement flap
  • Gracilis transfer
  • Coloanal anastomosis
  • Sphincteroplasty