The repair of rectovaginal fistulas using a bulbocavernosus muscle-fat flap

A 50-year-old woman developed a rectovaginal fistula after a posterior colporrhaphy for rectocele repair. Her vagina was scarred and narrowed after radiotherapy for cervical cancer 20 years earlier. A second patient with a 23-year history of Crohn's disease presented with a small low rectovaginal fistula. The latter appeared spontaneously. Both complained of passing faeces and flatus through the vagina. Clinical examination confirmed the symptoms and revealed no signs of sphincter disturbance. As both patients had no other medical problems, we operated on the fistulas by a vaginal approach using a bulbocavernosus muscle-fat flap from the right labia majora. A temporary ileo- or colostomy could be avoided. Following successful healing, the anatomical and functional results were excellent in both cases.