Laparoscopic management of iatrogenic high rectovaginal fistulas (Type VI)

Most rectovaginal fistulas are acquired. Obstetrical trauma and types of surgery such as laparoscopic-assisted vaginal hysterectomy may cause high rectovaginal fistulas. The high fistulas are repaired by abdominal approach, while middle or low fistulas are best approached perineally. There are not many reports of totally-laparoscopic repair available in the literature. We present two patients who had a (Type VI) high rectovaginal fistula following laparoscopicassisted vaginal hysterectomy. Laparoscopic repair was successfully performed by suturing the defects and fixing an omental patch between the rectum and vagina. The postoperative period was uneventful. Diagnosis and exact location of the fistula is critical in the management. Laparoscopic repair of high rectovaginal fistulas is feasible in most patients. Proper identification of tissue planes and good laparoscopic suturing technique is crucial for success. The issue of rectovaginal fistulas needs to be addressed in this era of laparoscopy, with particular reference to laparoscopy-assisted vaginal hysterectomy.