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German S3-Guideline: rectovaginal fistula.
Andreas Ommer1, Alexander Herold, Eugen Berg
1End- und Dickdarmpraxis, Essen, Germany. aommer@online.de
German Medical Science : GMS E-Journal
|December 21, 2012
Summary
Rectovaginal fistulas, often caused by trauma, require surgical treatment. Diagnosis involves patient history, clinical exam, and imaging, with surgical planning considering sphincter function.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Gynecologic Surgery
Background:
- Rectovaginal fistulas are rare, predominantly resulting from trauma (obstetric, surgical) or infection.
- This guideline excludes rectovaginal fistulas associated with inflammatory bowel disease.
Purpose of the Study:
- To provide guidance on the diagnosis and treatment of rectovaginal fistulas.
- To consolidate clinical experience and literature for managing these rare conditions.
Main Methods:
- A systematic literature review was conducted.
- Diagnosis relies on patient history, clinical examination, and imaging (endoscopy, endosonography, tomography).
Main Results:
- Surgical intervention is typically necessary for persistent rectovaginal fistulas.
- Treatment options include transrectal, transperineal, and abdominal approaches, with sphincter function assessment crucial for planning.
- Stoma creation may be required based on defect extent and patient burden.
Conclusions:
- This S3-Guideline offers the first comprehensive instructions for rectovaginal fistula diagnosis and treatment in Germany.
- Recommendations are largely based on clinical expertise due to limited supporting literature, indicating a descriptive character.
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