[Surgical treatment of recto-vaginal fistulas]

The article discusses 15-year experience in the treatment of 280 patients with various forms of rectovaginal fistulas. The choice of the operative method was differentiated on basis of complex appraisal of the etiology of the disease, pronouncement of the cicatricial and inflammatory changes, the level of the communication, relation of the fistula to the sphincter ani, and the functional condition of the rectal obturator apparatus. Most of the patients were subjected to combined interventions--excision of the fistula and local myoplasty (62%). Pyoinflammatory phenomena were the most frequent complications (17.2%) in the immediate postoperative period. The late-term results were studied in 249 patients, recurrent fistulas were found in 10.4% of cases, postoperative sphincter ani incompetence which called for plastic operations was discovered in 2.4% of patients. A differentiated choice of the method of surgical intervention made it possible to reduce in the recent years the frequency of recurrent fistulas from 15.2 to 6.4%, and the postoperative incompetence of the sphincter ani from 4.4 to 2.2%.