[Rectovaginal fistulas : Differentiated diagnostics and treatment]

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Gynecologic Surgery

Background:

• Rectovaginal fistulas (RVF) are uncommon, comprising less than 5% of anorectal fistulas.
• Etiologies include birth trauma, Crohn's disease, prior surgery, and pelvic irradiation.
• Classification depends on location (low/high) and cause.

Purpose of the Study:

• To review the classification, diagnosis, and surgical management of rectovaginal fistulas.
• To highlight diagnostic modalities and surgical approaches based on RVF characteristics.

Main Methods:

• Clinical assessment is often sufficient for diagnosis.
• Endosonography aids in detecting sphincter defects.
• CT and MRI are utilized for complex cases, post-irradiation, or Crohn's disease.

Main Results:

• Surgical techniques vary from local repairs to tissue interposition and transabdominal approaches for high RVF.
• High recurrence rates are common across all surgical procedures.
• Multiple operations and potential stoma creation are frequently required.

Conclusions:

• RVF management requires tailored surgical strategies based on localization and etiology.
• Despite various surgical options, achieving a definitive cure remains challenging due to high recurrence rates.