Skip to main content
SpringerLink
Log in

Management of Rectovaginal Fistula

  • Chapter
  • First Online:
Gastrointestinal Surgery

  • 2314 Accesses

Abstract

A rectovaginal fistula (RVF) is defined as an abnormal epithelial-lined connection between the rectum and vagina. It represents a disabling condition for the patients and a challenge for surgeons due to the 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. RVFs are due to various conditions, including obstetric injury, cryptoglandular infection, inflammatory bowel disease, rectal or vaginal surgery, radiation, neoplasia, or accidental injury. In this chapter, we review the current options for management of RVFs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rivadeneira DE, Ruffo B, Amrani S, Salinas C. Rectovaginal fistulas: current surgical management. Clin Colon Rectal Surg. 2007;20(2):96–101.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Debeche-Adams TH, Bohl JL. Rectovaginal fistulas. Clin Colon Rectal Surg. 2010;23(2):99–103.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Tsang CB, Madoff RD, Wong WD, Rothenberger DA, Finne CO, Singer D, Lowry AC. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum. 1998;41(9):1141–6.

    Article  CAS  PubMed  Google Scholar 

  4. Khanduja KS, Yamashita HJ, Wise WE Jr, Aguilar PS, Hartmann RF. Delayed repair of obstetric injuries of the anorectum and vagina. A stratified surgical approach. Dis Colon Rectum. 1994;37(4):344–9.

    Article  CAS  PubMed  Google Scholar 

  5. Stoker J, Rociu E, Schouten WR, Lame’ris JS. Anovaginal and rectovaginal fistulas: endoluminal sonography versus endoluminal MR imaging. AJR Am J Roentgenol. 2002;178(3):737–41.

    Article  PubMed  Google Scholar 

  6. Alexander AA, Liu JB, Merton DA, Nagle DA. Fecal incontinence: transvaginal US evaluation of anatomic causes. Radiology. 1996;199(2):529–32.

    Article  CAS  PubMed  Google Scholar 

  7. Kosugi C, Saito N, Kimata Y, Ono M, Sugito M, Ito M, Sato K, Koda K, Miyazaki M. Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair. Surgery. 2005;137(3):329–36.

    Article  PubMed  Google Scholar 

  8. Matthiessen P, Hansson L, Sjödahl R, Rutegård J. Anastomotic vaginal fistula (AVF) after anterior resection of the rectum for cancer—occurrence and risk factors. Colorectal Dis. 2010;12(4):351–7.

    Article  CAS  PubMed  Google Scholar 

  9. Yodonawa S, Ogawa I, Yoshida S, Ito H, Kobayashi K, Kubokawa R. Rectovaginal fistula after low anterior resection for rectal cancer using a double stapling technique. Case Rep Gastroenterol. 2010;4(2):224–8.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Shin US, Kim CW, Yu CS, Kim JC. Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Colorectal Dis. 2010;25(7):843–9.

    Article  PubMed  Google Scholar 

  11. Kim CW, Kim JH, Yu CS, Shin US, Park JS, Jung KY, Kim TW, Yoon SN, Lim SB, Kim JC. Complications after sphincter-saving resection in rectal cancer patients according to whether chemo-radiotherapy is performed before or after surgery. Int J Radiat Oncol Biol Phys. 2010;78(1):156–63.

    Article  PubMed  Google Scholar 

  12. Penninckx F, Moneghini D, D'Hoore A, Wyndaele J, Coremans G, Rutgeerts P. Success and failure after repair of rectovaginal fistula in Crohn’s disease: analysis of prognostic factors. Colorectal Dis. 2001;3(6):406–11.

    Article  CAS  PubMed  Google Scholar 

  13. Andreani SM, Dang HH, Grondona P, Khan AZ, Edwards DP. Rectovaginal fistula in Crohn’s disease. Dis Colon Rectum. 2007;50(12):2215–22.

    Article  CAS  PubMed  Google Scholar 

  14. Hannaway CD, Hull TL. Current considerations in the management of rectovaginal fistula from Crohn’s disease. Colorectal Dis. 2008;10(8):747–55. Discussion 755–6.

    Article  CAS  PubMed  Google Scholar 

  15. Ruffolo C, Scarpa M, Bassi N, Angriman I. A systematic review on advancement flaps for rectovaginal fistula in Crohn’s disease: transrectal vs transvaginal approach. Colorectal Dis. 2010;12(12):1183–91.

    Article  CAS  PubMed  Google Scholar 

  16. Zhu YF, Tao GQ, Zhou N, Xiang C. Current treatment of rectovaginal fistula in Crohn’s disease. World J Gastroenterol. 2011;17(8):963–7.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Wise WE Jr, Aguilar PS, Padmanabhan A, Meesig DM, Arnold MW, Stewart WR. Surgical treatment of low rectovaginal fistulas. Dis Colon Rectum. 1991;34(3):271–4.

    Article  PubMed  Google Scholar 

  18. Kodner IJ, Mazor A, Shemesh EI, Fry RD, Fleshman JW, Birnbaum EH. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas. Surgery. 1993;114(4):682–9. Discussion 689–90.

    CAS  PubMed  Google Scholar 

  19. Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum. 1996;39(1):10–4.

    Article  CAS  PubMed  Google Scholar 

  20. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45(12):1622–8.

    Article  PubMed  Google Scholar 

  21. Mizrahi N, Wexner SD, Zmora O, Da Silva G, Efron J, Weiss EG, Vernava AM 3rd, Nogueras JJ. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum. 2002;45(12):1616–21.

    Article  PubMed  Google Scholar 

  22. Ellis CN, Clark S. Effect of tobacco smoking on advancement flap repair of complex anal fistulas. Dis Colon Rectum. 2007;50(4):459–63.

    Article  PubMed  Google Scholar 

  23. de Parades V, Dahmani Z, Blanchard P, Zeitoun JD, Sultan S, Atienza P. Endorectal advancement flap with muscular plication: a modified technique for rectovaginal fistula repair. Colorectal Dis. 2011;13(8):921–5.

    Article  PubMed  Google Scholar 

  24. Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg. 1997;173:95–8.

    Article  CAS  PubMed  Google Scholar 

  25. Rahman MS, Al-Suleiman SA, El-Yahia AR, Rahman J. Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years’ experience in a teaching hospital. J Obstet Gynaecol. 2003;23:607–10.

    Article  CAS  PubMed  Google Scholar 

  26. Bauer JJ, Sher ME, Jaffin H, Present D, Gelerent I. Transvaginal approach for repair of rectovaginal fistulae complicating Crohn’s disease. Ann Surg. 1991;213:151–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. 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):581–6.

    PubMed  Google Scholar 

  28. Bleier JI, Moloo H, Goldberg SM. Ligation of intersphincteric fistula tract: an effective technique for complex fistulae. Dis Colon Rectum. 2010;53(1): 43–6.

    Article  PubMed  Google Scholar 

  29. Ommer A, Herold A, Berg E, Fürst A, Schiedeck T, Sailer M. German S3-Guideline: rectovaginal fistula. Ger Med Sci. 2012;10:Doc15

    PubMed Central  PubMed  Google Scholar 

  30. Champagne BJ, O’Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006;49:1817–21.

    Article  PubMed  Google Scholar 

  31. Abel ME, Chiu YS, Russell TR, Volpe PA. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum. 1993;36: 447–9.

    Article  CAS  PubMed  Google Scholar 

  32. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum. 2004;47:432–6.

    Article  PubMed  Google Scholar 

  33. Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum. 2008;51(7):1084–8.

    Article  PubMed  Google Scholar 

  34. Van Koperen PJ, Bemeiman WA, Bossuyt PM, 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.

    Article  Google Scholar 

  35. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008;51(6):838–43.

    Article  PubMed  Google Scholar 

  36. 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):1877–81.

    Article  PubMed  Google Scholar 

  37. García-Olmo D, García-Arranz M, García LG, Cuellar ES, Blanco IF, Prianes LA, Montes JA, Pinto FL, Marcos DH, García-Sancho L. Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn’s disease: a new cell-based therapy. Int J Colorectal Dis. 2003;18(5):451–4.

    Article  PubMed  Google Scholar 

  38. Li Destri G, Scilletta B, Tomaselli TG, Zarbo G. Rectovaginal fistula: a new approach by stapled transanal rectal resection. J Gastrointest Surg. 2008;12(3):601–3.

    Article  PubMed  Google Scholar 

  39. D'Ambrosio G, Paganini AM, Guerrieri M, Barchetti L, Lezoche G, Fabiani B, Lezoche E. Minimally invasive treatment of rectovaginal fistula. Surg Endosc. 2012;26(2):546–50.

    Article  PubMed  Google Scholar 

  40. Lamazza A, Fiori E, Sterpetti AV, Schillaci A, Scoglio D, Lezoche E Self-expandable metal stents in the treatment of benign anastomotic stricture after rectal resection for cancer. Colorectal Dis. 2013;O150–3

    Google Scholar 

  41. Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M. Gracilis muscle transposition for fistulas between the rectum and urethra or vagina. Dis Colon Rectum. 2006;49:1316–21.

    Article  PubMed  Google Scholar 

  42. Tran KT, Kuijpers HC, van Nieuwenhoven EJ, van Goor H, Spauwen PH. Transposition of the rectus abdominis muscle for complicated pouch and rectal fistulas. Dis Colon Rectum. 1999;42:486–9.

    Article  CAS  PubMed  Google Scholar 

  43. Horch RE, 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;60:502–7.

    Article  PubMed  Google Scholar 

  44. White AJ, Buchsbaum HJ, Blythe JG, Lifshitz S. Use of the bulbocavernosus muscle (Martius procedure) for repair of radiation-induced rectovaginal fistulas. Obstet Gynecol. 1982;60:114–8.

    CAS  PubMed  Google Scholar 

  45. Aartsen EJ, Sindram IS. Repair of the radiation induced rectovaginal fistulas without or with interposition of the bulbocavernosus muscle (Martius procedure). Eur J Surg Oncol. 1988;14:171–7.

    CAS  PubMed  Google Scholar 

  46. Ulrich D, Roos J, Jakse G, Pallua N. Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Reconstr Aesthet Surg. 2009;62:352–6.

    Article  PubMed  Google Scholar 

  47. Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248:39–43.

    Article  PubMed  Google Scholar 

  48. Kin C, Gurland B, Zutshi M, Hull T, Krummel T, Remzi F. Martius flap repair for complex rectovaginal fistula. Pol Przegl Chir. 2012;84(11):601–4.

    PubMed  Google Scholar 

  49. McNevin MS, Lee PY, Bax TW. Martius flap: an adjunct for repair of complex, low rectal vaginal fistula. Am J Surg. 2007;193:596–9.

    Article  Google Scholar 

  50. Pitel S, Lefevre JH, Parc Y, et al. Martius advancement flap for low rectovaginal fistula: short- and long-term results. Colorectal Dis. 2011;13:112–5.

    Article  Google Scholar 

  51. Elkins TE, DeLancey JO, McGuire EJ. The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair. Obstet Gynecol. 1990;75:727–33.

    CAS  PubMed  Google Scholar 

  52. Boronow RC. Repair of radiation-induced rectovaginal fistula utilizing the Martius technique. World J Surg. 1986;10:237–48.

    Article  CAS  PubMed  Google Scholar 

  53. Parks AG, Allen CL, Frank JD, McPartlin JF. A method of treating post-irradiation rectovaginal fistulas. Br J Surg. 1978;65:417–21.

    Article  CAS  PubMed  Google Scholar 

  54. Nowacki MP. Ten years of experience with Parks’ coloanal sleeve anastomosis for the treatment of post-irradiation rectovaginal fistula. Eur J Surg Oncol. 1991;17:563–6.

    CAS  PubMed  Google Scholar 

  55. Cooke SA, Wellsted MD. The radiation-damaged rectum: resection with coloanal anastomosis using the endoanal technique. World J Surg. 1986;10:220–7.

    Article  CAS  PubMed  Google Scholar 

  56. Bricker EM, Johnston WD. Repair of post irradiation rectovaginal fistula and stricture. Surg Gynecol Obstet. 1979;148:499–506.

    CAS  PubMed  Google Scholar 

  57. Steichen FM, Barber HK, Loubeau JM, Iraci JC. Bricker-Johnston sigmoid colon graft for repair of post radiation rectovaginal fistula and stricture performed with mechanical sutures. Dis Colon Rectum. 1992;35:599–603.

    Article  CAS  PubMed  Google Scholar 

  58. Schwenk W, Bohm B, Grundel K, Muller J. Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty. Surg Endosc. 1997;11:147–9.

    Article  CAS  PubMed  Google Scholar 

  59. Pelosi MA III, Pelosi MA. Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization. J Laparoendosc Adv Surg Tech A. 1997;7:379–83.

    Article  PubMed  Google Scholar 

  60. Kumaran SS, Palanivelu C, Kavalakat AJ, Parthasarathi R, Neelayathatchi M. Laparoscopic repair of high rectovaginal fistula: is it technically feasible? BMC Surg. 2005;5:20.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Schloericke E, Hoffmann M, Zimmermann M, Kraus M, Bouchard R, Roblick UJ, Hildebrand P, Nolde J, Bruch HP, Limmer S. Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas. Colorectal Dis. 2012;14(5):604–10.

    Article  CAS  PubMed  Google Scholar 

  62. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, Tanaka Y, Suzuki K, Masuda J, Tanaka M. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis. 2006;21(7):676–82.

    Article  PubMed  Google Scholar 

  63. Tunuguntla HS, Gousse AE. Female sexual dysfunction following vaginal surgery: a review. J Urol. 2006;175(2):439–46.

    Article  PubMed  Google Scholar 

  64. El-Gazzaz G, Hull TL, Mignanelli E, Hammel J, Gurland B, Zutshi M. Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function. J Gastrointest Surg. 2010;14(11):1758–63.

    Article  PubMed  Google Scholar 

  65. Ommer A, Athanasiadis S, Köhler A, Psarakis E. Die Bedeutungder Stomaanlageim Rahmen der Behandlung der komplizierten Analfisteln und der rektovaginalen Fisteln. Coloproctology. 2000;22:14–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington Medical Center, 1959 NE Pacific St, Box 356410, 98195, Seattle, WA, USA

    Daniele Scoglio MD & Alessandro Fichera MD, FACS, FASCRS

Authors
  1. Daniele Scoglio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Fichera MD, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Fichera MD, FACS, FASCRS .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Timothy M. Pawlik

  2. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA

    Shishir K. Maithel

  3. Professor of Surgery, Division of Surgical Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida, USA

    Nipun B. Merchant

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Scoglio, D., Fichera, A. (2015). Management of Rectovaginal Fistula. In: Pawlik, T., Maithel, S., Merchant, N. (eds) Gastrointestinal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2223-9_37

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2223-9_37

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2222-2

  • Online ISBN: 978-1-4939-2223-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation