Rectovaginal Fistulas, Their Surgical Management, and Outcomes: An Indian Experience

Background Rectovaginal fistulas (RVFs) are abnormal epithelial-lined tracts between the rectum and vagina that significantly impact quality of life. Their etiology is varied, and most cases require surgical repair. Multiple surgical approaches exist, with varying success rates ranging from very low to high. However, data from India on surgical outcomes remain limited. This study, conducted at a tertiary care center in North India, aims to evaluate the outcomes of RVF repair and identify factors associated with surgical success. Methodology This was a retrospective analysis of prospectively maintained data of all patients (n = 72) with RVF who were managed between 2005 and 2023 at a tertiary care hospital in North India. IBM SPSS Statistics software for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA) was used for statistical analyses. Continuous variables are presented as mean and standard deviation (SD) or median (interquartile range (IQR)), depending on normality status, while categorical variables are reported as raw values with percentages. Univariate analysis was performed using Pearson's chi-square and Fisher's exact tests. A p-value <0.05 was considered significant. Results A total of 72 patients were managed for RVF. Various etiological factors were iatrogenic injury in 23 (31.9%) patients, obstetric causes in 18 (25%) patients, malignancy in 19 (26%) patients, and congenital anomalies in five (7%) patients. Forty-eight (67%) patients required surgical intervention. Among those who underwent surgical intervention, various techniques were utilized: transvaginal layered closure in 24 (50%) patients, transvaginal advancement flap repair in 15 (31.3%) patients, transperineal layered closure with the Martius flap interposition in seven (14.6%) patients, and coloanal anastomosis in two (2.7%) patients. Fourteen (29%) patients required more than one surgical procedure. The overall success rate following surgical repair was 70.8%. No clinical or demographic factors were found to be statistically significant predictors of surgical failure. Conclusions In our study, the most common cause of RVF was iatrogenic injury. The majority of patients required surgical repair, with outcomes comparable to those reported in the literature. Among the various factors analyzed for their potential influence on surgical success, none were found to be significantly associated with the outcome.