[Diagnosis and surgical treatment for rectovaginal fistula]

Rectovaginal fistulas are distressing conditions to patients and present a therapeutic challenge to surgeons. Whether the etiology of the fistula is obstetric, Crohn's disease-related, or cryptoglandular, a thorough anatomy evaluation is required in order to select the correct repair. No single surgical technique is suitable for all rectovaginal fistulas as of now. Less invasive surgery should be selected in primary repair, and endorectal advancement flap repair was recommended as the first line therapy in most guidelines for the treatment of rectovaginal fistulas. Preoperative fecal diversion has not been shown consistently to lead to better outcomes, thus most surgeons suggested that diverting stoma is not imperative in majority of patients, unless the tissue interposition was undertaken. The tissue interposition or transabdominal repair should be considered for multiple failure or recurrent complex rectovaginal fistulas. Familiarity with the various surgical techniques described and the ability to apply the appropriate surgery to correct patients will increase the chance of a successful intervention.