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Diseases of the Colon & Rectum

, Volume 38, Issue 1, pp 4–6 | Cite as

Operative repair of anovaginal and rectovaginal fistulas

  • W. Patrick Mazier
  • Anthony J. Senagore
  • Elaine C. Schiesel
Original Contributions

Abstract

PURPOSE: Operative repair of low rectovaginal fistulas should be tailored to the specific anatomic defect. Endoanal flap repair frequently provides successful fistula closure; however, if substantial injury to the perineal body, anal sphincter, or rectovaginal septum exists, a more extensive repair is required. We present our experience with 95 consecutive patients, operated for rectovaginal fistulasviaseptal repair after conversion to a fourth degree perineal laceration, endoanal flap, or anoperineorrhaphy. METHODS: A retrospective chart review was performed. Data collected included etiology, location, size, repair type, and degree of anal continence. All patients received standard mechanical and antibiotic bowel preparation and parenteral antibiotics. No covering stomas were used. RESULTS: Fistula etiology included obstetric injury (N=77), perianal cryptoglandular infection (N=15), and other (N=3). Thirty-one patients had previous unsuccessful repairs. Types of repairs were fourth degree perineal laceration (38), endoanal flap (19), and anoperineorrhaphy (38). Excellent or good functional results occurred in 92 patients (97 percent). Similar success occurred in patients with previous failed repairs (90 percent excellent or good). The recurrence rate was 3 percent. There were no outcome differences between techniques. CONCLUSION: We believe that all three types of repair for rectovaginal fistulas result in a high cure rate, thereby allowing operative technique to be tailored to the anatomic defects present. This approach should allow for optimal functional outcome.

Key words

Fistula Rectovaginal Surgery Fistula repair 

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References

  1. 1.
    Laird DR. Procedures used in treatment of complicated fistulas. Am J Surg 1948;76:701–8.Google Scholar
  2. 2.
    Lescher TC, Pratt JH. Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 1967;124:1317–21.Google Scholar
  3. 3.
    Bandy LC, Addison A, Parker RT. Surgical management of rectovaginal fistulas in Crohn's disease. Am J Obstet Gynecol 1983;147:359–63.Google Scholar
  4. 4.
    Legino LJ, Woods MP, Rayburn WF, McGoogan LS. Third and fourth degree perineal tears: 50 years' experience at a university hospital. J Reprod Med 1988;33:423–6.Google Scholar
  5. 5.
    Stern H, Gamliel Z, Ross T, Dreznik Z. Rectovaginal fistula: initial experience. Can J Surg 1988;31:359–62.Google Scholar
  6. 6.
    Rothenberger DA, Christenson CE, Balcos EG,et al. Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum 1982;25:297–300.Google Scholar
  7. 7.
    Belt RL Jr, Belt RL. Repair of anorectal vaginal fistula utilizing segmental advancement of the internal sphincter muscle. Dis Colon Rectum 1969;12:99–104.Google Scholar
  8. 8.
    Laird DR. Procedures used in treatment of complicated fistulas. Am J Surg 1948;76:701–8.Google Scholar
  9. 9.
    Hoexter B, Labow SB, Moseson MD. Transanal rectovaginal fistula repair. Dis Colon Rectum 1985;28:572–5.Google Scholar
  10. 10.
    Hankins GD, Hauth JC, Gilstrap LC,et al. Early repair of episiotomy dehiscence. Obstet Gynecol 1990;75:48–51.Google Scholar
  11. 11.
    Given FT Jr. Rectovaginal fistula: a review of 20 years' experience in a community hospital. Am J Obstet Gynecol 1970;108:41–6.Google Scholar
  12. 12.
    Hibbard LT. Surgical management of rectovaginal fistulas and complete perineal tears. Am J Obstet Gynecol 1978;130:139–40.Google Scholar
  13. 13.
    Wiskind AK, Thomson JD. Transverse transperineal repair of rectovaginal fistulas in the lower vagina. Am J Obstet Gynecol 1992;167:694–9.Google Scholar
  14. 14.
    Senagore A. Treatment of acquired rectovaginal fistulas. Semin Colon Rectal Surg 1990;1:219–23.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1995

Authors and Affiliations

  • W. Patrick Mazier
    • 1
    • 2
  • Anthony J. Senagore
    • 1
    • 2
  • Elaine C. Schiesel
    • 1
  1. 1.Department of Colorectal SurgeryFerguson-Blodgett Digestive Disease InstituteGrand Rapids
  2. 2.Department of SurgeryMichigan State UniversityEast Lansing

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