[Current situation in the diagnosis and treatment of rectovaginal fistula]

The treatment of rectovaginal fistula is quite difficult. It is a formidable challenge for anorectal surgeons to successfully perform operations for rectovaginal fistulas, since both recurrence rate and incontinence rate are high. This commentary elucidates certain questions during the treatment course of rectovaginal fistula through reviewing relevant literature and our clinical practice, including the overall evaluation of the preoperative rectovaginal fistula, the choice of suitable operation timing, reasonable choice of operational procedure and standard perioperative management. Precise special examination is the base of diagnosis. Magnetic resonance and rectal Doppler ultrasound can be helpful to make a precise and standard diagnosis of rectovaginal fistula. Suitable operation timing and satisfactory intestinal preparation are the premise of successful operation. Despite the variety of the surgical treatment, there is still no standard surgical technique with respect to rectovaginal fistula. Individualization must be considered based on the anatomic features of rectovaginal fistula, its surrounding tissues, the integrity of anal sphincter, and operative repair before. Perioperative management is important both in the increase of successful operation rate and the decrease of recurrence rate.