Conservative treatment of low rectovaginal fistula in Crohn's disease

A conservative operative treatment of anovaginal fistula in Crohn's disease is described. This consists of simply laying open the fistula with section of the rectovaginal septum and the portion of external sphincter superficial to the fistula. The operation may be performed in the presence of rectal involvement even during an acute exacerbation of the disease; a temporary defunctioning stoma is not required. The fistula was of the high transsphincteric type in three patients and low transsphincteric in six. All wounds healed in less than 3 months without any further surgery. At a mean follow-up of 29 months, 6 had perfect continence and 3 could control solid but not liquid stools nor flatus.