Transanal rectovaginal fistula repair

In this update, 15 additional successful transanal repairs followed for one to six years postoperatively for low rectovaginal fistulas without colostomies are added to the uniformly successful 20 patients presented in a 1978 report. Changes in perioperative routines have greatly enhanced cost efficiency and these modifications are enumerated. The repair still encompasses total excision of the epithelialized fistula, and reapproximation of the attenuated septal fibers and anal sphincter mechanism, as well as the caudad rectal mucosal advancement that covers and protects the repair from the fecal stream and the high intraluminal pressures of defecation. Once again, we have excluded inflammatory, neoplastic, and irradiation-caused fistulas from this discussion, although we, as well as others, have applied this technique in selected cases.