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Rectovaginal fistula
1Rush Medical College, Rush University, 600 South Paulina Street, Chicago, IL 60612, USA. Theodore_Saclarides@rush.edu
The Surgical Clinics of North America
|January 9, 2003
Summary
Management of rectovaginal fistulas depends on the cause. Obstetrical fistulas may be treated locally, while Crohn's or radiation fistulas often require more complex surgical interventions or diversion.
Area of Science:
- Gastroenterology
- Gynecology
- Colorectal Surgery
Background:
- Rectovaginal fistulas pose significant challenges for patients and physicians.
- Successful management requires careful consideration of fistula etiology and patient health.
Purpose of the Study:
- To outline the management strategies for rectovaginal fistulas based on their underlying causes.
- To provide a framework for treating diverse etiologies including obstetrical, Crohn's-related, and radiation-induced fistulas.
Main Methods:
- Review of management principles for different types of rectovaginal fistulas.
- Discussion of surgical approaches including local repair, proctectomy, and fecal diversion.
- Emphasis on excluding cancer recurrence in radiation-induced fistulas.
Main Results:
- Obstetrical fistulas are often amenable to local transanal or transvaginal repair.
- Severe rectal involvement in Crohn's disease may necessitate proctectomy.
- Radiation-induced fistulas require exclusion of cancer recurrence; fecal diversion may be an option if resection is not feasible.
Conclusions:
- Tailored management strategies are crucial for successful rectovaginal fistula treatment.
- Etiology-specific approaches, ranging from local repair to proctectomy or diversion, are essential.
- Patient health and exclusion of malignancy are key factors in treatment planning.