Challenges that define approaches for rectovaginal fistula repair

This article reviews recent literature to assess the challenges that define approaches in rectovaginal fistula (RVF) repair. RVFs remain a significant clinical challenge because of their profound impact on patient quality of life and the absence of standardized management strategies. The predominance of small studies and case series limits the ability to determine the most effective repair techniques. Consequently, a synthesis of contemporary evidence is needed to better inform decisions regarding surgical timing, technique selection, and optimization of patient comorbidities.

Sphincter-preserving techniques continue to show promise for low- and mid-level fistulas. Fecal diversion may benefit patients with recurrent RVF or prior failed repairs, and the Martius flap remains a mainstay for complex cases, with the Musset technique emerging as a potential alternative. Multidisciplinary teams remain essential for repair success. Postoperative strategies, including negative pressure dressings and hyperbaric oxygen therapy, show potential for improving healing and reducing RVF recurrence.

RVF remains a debilitating condition. Optimizing surgical timing, managing comorbid conditions, and tailoring operative and postoperative care through multidisciplinary collaboration are essential to achieving optimal patient outcomes. Further research is needed to clarify long-term functional results and refine emerging repair techniques, especially in those with recurrent RVFs.