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Updated: Apr 16, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic
Susan H Oakley1, Heidi W Brown, Ladin Yurteri-Kaplan
1From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH; †Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego Health System & Kaiser Permanente, San Diego, CA; ‡Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC; §Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; ∥Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stanford University School of Medicine, Stanford, CA; ¶Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; **Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX; ††Division of Urogynecology, University of South Florida, Tampa, FL; ‡‡Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; §§Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH; ∥∥Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA; and ¶¶Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL.
Objectives:
Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States.
Methods:
This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected.
Results:
Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (<0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists.
Conclusions:
In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (<0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
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