Management of Rectovaginal Fistulae

A rectovaginal fistula is an epithelialized connection between the rectum and the vagina. These fistulae are stratified based on location, complexity, sphincter damage, and the status of the surrounding tissue. Multiple surgical treatments options are available and should be individualized based on the specific circumstances. Even in the most experienced hands recurrences are common. Recurrent fistulae often require the precise placement of well-vascularized transpositional flaps. Diversion is frequently required to control the symptoms of vaginal soilage and urinary tract infections, but it does not appear to definitively prevent recurrence. Almost all patients can eventually be successfully closed.