Abstract
Although typically small in size and seemingly simple, rectovaginal fistulas are an aggravation to the patients and surgeons. Passing flatus or stool through the vagina is understandably distressing to patients; the lack of a uniformly successful repair is frustrating to surgeons.
References
Homsi R, Daikoku NH, Littlejohn J, Wheeless CR Jr. Episiotomy: risks of dehiscence and rectovaginal fistula. Obstet Gynecol Surv 1994;49:803–808.
Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA. Anorectal complications of vaginal delivery. Dis Colon Rectum 1989;32:1039–1041.
Beynon CL. Midline episiotomy as a routine procedure. J Obstet Gynaecol Br Commonw 1974;81:126–130.
Margolis T, Elkins TE, Seffah J, Oparo‐Addo HS, Fort D. Full‐thickness Martius grafts to preserve vaginal depth as an adjunct in the repair of large obstetric fistulas. Obstet Gynecol 1994; 84:148–152.
Hamlin C, Turnbull GB. The treatment of rectovaginal and vesicovaginal fistulas in women with childbirth injuries in Ethiopia. J Wound Ostomy Continence Nurs 1997;24:187–189.
Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002;122:875–880.
Radcliffe AG, Ritchie JK, Hawley PR, Lennard‐Jones JE, Northover JM. Anovaginal and rectovaginal fistulas in Crohn's disease. Dis Colon Rectum 1988;31:94–99.
Nakagoe T, Sawai T, TujiT, et al. Avoidance of rectovaginal fistula as a complication after low anterior resection for rectal cancer using a double‐stapling technique. J Surg Oncol 1999; 71:196–197.
Groom JS, Nicholls RJ, Hawley PR, Phillips RK. Pouch‐vaginal fistula. Br J Surg 1993;80:936–940.
O'Kelly TJ, Merrett M, Mortensen NJ, Dehn TC, Kettlewell M. Pouch‐vaginal fistula after restorative proctocolectomy: aetiology and management. Br J Surg 1994;81:1374–1375.
Paye F, Penna C, Chiche L, Tiret E, Frileux P, Parc R. Pouch‐related fistula following restorative proctocolectomy. Br J Surg 1996;83:1574–1577.
Wexner SD, Rothenberger DA, Jensen L, et al. Ileal pouch vaginal fistulas: incidence, etiology, and management. Dis Colon Rectum 1989;32:460–465.
Schult M, Wolters HH, Lelle RJ, Winde G, Senninger N. Outcome of surgical intervention for rectoneovaginal fistulas in Mayer‐Rokitansky‐Kuester‐Hauser syndrome. World J Surg 2001;25:438–440.
Schwartz J, Rabinowitz H, Rozenfeld V, Leibovitz A, Stelian J, Habot B. Rectovaginal fistula associated with fecal impaction. J Am Geriatr Soc 1992;40:641.
Hoffman MS, Wakeley KE, Cardosi RJ. Risks of rigid dilation for a radiated vaginal cuff: two related rectovaginal fistulas. Obstet Gynecol 2003;101:1125–1126.
Sharland M, Peake J, Davies EG. Pseudomonal rectovaginal abscesses in HIV infection. Arch Dis Child 1995;72:275.
Parra JM, Kellogg ND. Repair of a recto‐vaginal fistula as a result of sexual assault. Semin Perioper Nurs 1995;4:140–145.
Bird D, Taylor D, Lee P. Vaginography: the investigation of choice for vaginal fistulae? Aust N Z J Surg 1993;63:894–896.
Giordano P, Drew PJ, Taylor D, Duthie G, Lee PW, Monson JR. Vaginography: investigation of choice for clinically suspected vaginal fistulas. Dis Colon Rectum 1996;39:568–572.
Stoker J, Rociu E, Schouten WR, Lameris JS. Anovaginal and rectovaginal fistulas: endoluminal sonography versus endoluminal MR imaging. AJR Am J Roentgenol 2002;178:737–741.
Yee LF, Birnbaum EH, Read TE, Kodner IJ, Fleshman JW. Use of endoanal ultrasound in patients with rectovaginal fistulas. Dis Colon Rectum 1999;42:1057–1064.
Sudol‐ Szopinska I, Jakubowski W, Szczepkowski M. Contrast‐enhanced endosonography for the diagnosis of anal and anovaginal fistulas. J Clin Ultrasound 2002;30:145–150.
Stewart LK, McGee J, Wilson SR. Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol 2001;177:627–632.
Tsang CB, Madoff RD, WongWD, et al. Anal sphincter integrity and function influences outcome in rectovaginal fistula repair. Dis Colon Rectum 1998;41:1141–1146.
Veronikis DK, Nichols DH, Spino C. The Noble‐Mengert‐Fish operation‐revisited: a composite approach for persistent rectovaginal fistulas and complex perineal defects. Am J Obstet Gynecol 1998;179:1411–1416; discussion 1416–1417.
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;37:344–349.
Allen‐Mersh TG, Wilson EJ, Hope‐Stone HF, Mann CV. The management of late radiation‐induced rectal injury after treatment of carcinoma of the uterus. Surg Gynecol Obstet 1987;164:521–524.
van Nagell JR Jr, Parker JC Jr, Maruyama Y, Utley J, Luckett P. Bladder or rectal injury following radiation therapy for cervical cancer. Am J Obstet Gynecol 1974;119:727–732.
Daniels B. Rectovaginal Fistula: A Clinical and Pathological Study. Pathology. Minneapolis: University of Minnesota; 1949.
Rothenberger DA, Goldberg SM. The management of rectovaginal fistulae. Surg Clin North Am 1983;63:61–79.
Saclarides TJ. Rectovaginal fistula. Surg Clin North Am 2002;82:1261–1272.
Abel ME, Chiu YS, Russell TR, Volpe PA. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum 1993;36:447–449.
Buchanan GN, Bartram CI, PhillipsRK, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum 2003;46:1167–1174.
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;47:432–436.
Venkatesh KS, Ramanujam P. Fibrin glue application in the treatment of recurrent anorectal fistulas. Dis Colon Rectum 1999;42:1136–1139.
Greenwald JC, Hoexter B. Repair of rectovaginal fistulas. Surg Gynecol Obstet 1978;146:443–445.
Hoexter B, Labow SB, Moseson MD. Transanal rectovaginal fistula repair. Dis Colon Rectum 1985;28:572–575.
Hyman N. Endoanal advancement flap repair for complex anorectal fistulas. Am J Surg 1999;178:337–340.
Joo JS, Weiss EG, Nogueras JJ, Wexner SD. Endorectal advancement flap in perianal Crohn's disease. Am Surg 1998;64:147–150.
Lowry AC, Thorson AG, Rothenberger DA, Goldberg SM. Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum 1988;31:676–678.
Mizrahi N, Wexner SD, ZmoraO, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 2002;45:1616–1621.
Russell TR, Gallagher DM. Low rectovaginal fistulas. Approach and treatment. Am J Surg 1977;134:13–18.
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: 1622–1628.
Wise WE Jr, Aguilar PS, Padmanabhan A, Meesig DM, Arnold MW, Stewart WR. Surgical treatment of low rectovaginal fistulas. Dis Colon Rectum 1991;34:271–274.
Zimmerman DD, Gosselink MP, Briel JW, Schouten WR. The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition. Tech Coloproctol 2002;6:37–42.
Baig MK, Zhao RH, YuenCH, et al. Simple rectovaginal fistulas. Int J Colorectal Dis 2000;15:323–327.
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;114:682–689; discussion 689–690.
Mac Rae HM, McLeod RS, Cohen Z, Stern H, Reznick R. Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum 1995;38:921–925.
Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum 1995; 38:4–6.
Watson SJ, Phillips RK. Non‐inflammatory rectovaginal fistula. Br J Surg 1995;82:1641–1643.
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; 39:10–14.
Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Smoking affects the outcome of transanal mucosal advancement flap repair of trans‐sphincteric fistulas. Br J Surg 2003;90:351–354.
Hibbard LT. Surgical management of rectovaginal fistulas and complete perineal tears. Am J Obstet Gynecol 1978;130:139–141.
Lawson J. Rectovaginal fistulae following difficult labour. Proc R Soc Med 1972;65:283–286.
Lescher TC, Pratt JH. Vaginal repair of the simple rectovaginal fistula. Surg Gynecol Obstet 1967;124:1317–1321.
Tancer ML, Lasser D, Rosenblum N. Rectovaginal fistula or perineal and anal sphincter disruption, or both, after vaginal delivery. Surg Gynecol Obstet 1990;171:43–46.
Wiskind AK, Thompson JD. Transverse transperineal repair of rectovaginal fistulas in the lower vagina. Am J Obstet Gynecol 1992;167:694–699.
Hesterberg R, Schmidt WU, Muller F, Roher HD. Treatment of anovaginal fistulas with an anocutaneous flap in patients with Crohn's disease. Int J Colorectal Dis 1993;8:51–54.
Haray PN, Stiff G, Foster ME. New option for recurrent rectovaginal fistulas. Dis Colon Rectum 1996;39:463–464.
Hull TL, Fazio VW. Surgical approaches to low anovaginal fistula in Crohn's disease. Am J Surg 1997;173:95–98.
Simmang CL, Lacey SW, Huber PJ Jr. Rectal sleeve advancement: repair of rectovaginal fistula associated with anorectal stricture in Crohn's disease. Dis Colon Rectum 1998; 41:787–789.
Mengert WF, Fish SA. Anterior rectal wall advancement: technique for repair of complete perineal laceration and recto‐vaginal fistula. Obstet Gynecol 1955;5:262–267.
Hilsabeck JR. Transanal advancement of the anterior rectal wall for vaginal fistulas involving the lower rectum. Dis Colon Rectum 1980;23:236–241.
Pepe F, Panella M, Arikian S, Panella P, Pepe G. Low rectovaginal fistulas. Aust N Z J Obstet Gynaecol 1987;27:61–63.
Hudson CN. Acquired fistulae between the intestine and the vagina. Ann R Coll Surg Engl 1970;46:20–40.
Given FT Jr. Rectovaginal fistula. A review of 20 years’ experience in a community hospital. Am J Obstet Gynecol 1970;108:41–46.
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;23:607–610.
Lowry AC, Goldberg SM. Simple rectovaginal fistula. In: Cameron J, ed. Current Surgical Therapy. 4th edition. St. Louis: Mosby; 1991.
Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C. Repair of recurrent rectovaginal fistulas. Surgery 2001;130:753–757; discussion 757–758.
Pinedo G, Phillips R. Labial fat pad grafts (modified Martius graft) in complex perianal fistulas. Ann R Coll Surg Engl 1998;80:410–412.
Rius J, Nessim A, Nogueras JJ, Wexner SD. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease. Eur J Surg 2000;166:218–222.
Shah NS, Remzi F, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch‐vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum 2003;46:911–917.
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;42:486–489.
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; 60:114–118.
Zacharin RF. Grafting as a principle in the surgical management of vesicovaginal and rectovaginal fistulae. Aust N Z J Obstet Gynaecol 1980;20:10–17.
Byron RL Jr, Ostergard DR. Sartorius muscle interposition for the treatment of the radiation‐induced vaginal fistula. Am J Obstet Gynecol 1969;104:104–107.
Chitrathara K, Namratha D, Francis V, Gangadharan VP. Spontaneous rectovaginal fistula and repair using bulbocavernosus muscle flap. Tech Coloproctol 2001;5:47–49.
Elkins TE, De Lancey JO, McGuire EJ. The use of modified Martius graft as an adjunctive technique in vesicovaginal and rectovaginal fistula repair. Obstet Gynecol 1990;75:727–733.
Gorenstein L, Boyd JB, Ross TM. Gracilis muscle repair of rectovaginal fistula after restorative proctocolectomy. Report of two cases. Dis Colon Rectum 1988;31:730–734.
Horch RE, Gitsch G, Schultze‐Seemann W. Bilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch‐vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds. Urology 2002;60:502–507.
Kaman L, Singh R, Kaplish B, Virk SS, Patel F. Gracilis repair for a case of radiation induced rectovaginal fistulae. Trop Gastroenterol 1999;20:92–93.
Onodera H, Nagayama S, Kohmoto I, Maetani S, Imamura M. Novel surgical repair with bilateral gluteus muscle patching for intractable rectovaginal fistula. Tech Coloproctol 2003;7: 198–202.
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;14:171–177.
Boronow RC. Repair of the radiation‐induced vaginal fistula utilizing the Martius technique. World J Surg 1986;10:237–248.
Parks AG, Allen CL, Frank JD, McPartlin JF. A method of treating post‐irradiation rectovaginal fistulas. Br J Surg 1978;65:417–421.
Nowacki MP, Szawlowski AW, Borkowski A. Parks’ coloanal sleeve anastomosis for treatment of postirradiation rectovaginal fistula. Dis Colon Rectum 1986;29:817–820.
Cooke SA, de Moor NG. The surgical treatment of the radiation‐damaged rectum. Br J Surg 1981;68:488–492.
Bricker EM, Johnston WD. Repair of postirradiation rectovaginal fistula and stricture. Surg Gynecol Obstet 1979;148:499–506.
Bricker EM, Kraybill WG, Lopez MJ. Functional results after postirradiation rectal reconstruction. World J Surg 1986;10: 249–258.
Mattingly R. Anal incontinence and rectovaginal fistulas. In: Mattingly R, ed. TeLindefs Operative Gynecology. Philadelphia: Lippincott; 1977:618–626.
Heyen F, Winslet MC, Andrews H, Alexander‐Williams J, Keighley MR. Vaginal fistulas in Crohn's disease. Dis Colon Rectum 1989;32:379–383.
Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398–1405.
Topstad DR, Panaccione R, Heine JA, Johnson DR, Mac Lean AR, Buie WD. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn's disease: a single center experience. Dis Colon Rectum 2003;46:577–583.
Ricart E, Sandborn WJ. Infliximab for the treatment of fistulas in patients with Crohn's disease. Gastroenterology 1999;117: 1247–1248.
Van Assche G, Vanbeckevoort D, Bielen D, et al. Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn's disease. Am J Gastroenterol 2003;98:332–339.
Rasul I, Wilson SR, Mac Rae H, Irwin S, Greenberg GR. Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn's disease. Am J Gastroenterol 2004;99:82–88.
Sher ME, Bauer JJ, Gelernt I. Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach. Dis Colon Rectum 1991;34:641–648.
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;32:497–499.
Nowacki MP. Ten years of experience with Parks’ coloanal sleeve anastomosis for the treatment of post‐irradiation rectovaginal fistula. Eur J Surg Oncol 1991;17:563–566.
Rex JC Jr, Khubchandani IT. Rectovaginal fistula: complication of low anterior resection. Dis Colon Rectum 1992;35:354–356.
Sugarbaker PH. Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer. J Surg Oncol 1996;61:155–158.
Civelli EM, Gallino G, ValvoF, et al. Correlation between radiotherapy and suture fistulas following colo‐anal anastomosis for carcinoma of the rectum evaluation of 152 consecutive patients. Tumori 2002;88:321–324.
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Lowry, A.C., Hoexter, B. (2007). Benign Anorectal: Rectovaginal Fistulas. In: Wolff, B.G., et al. The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_14
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