| Theme | Benign Lesions of Rectum and Anus | |
|---|---|---|
| Title | Rectovaginal Fistula | |
| Publish Date | 2000/07 | |
| Author | Akihiro Hori | Kumiai Hospital |
| [ Summary ] | Rectovaginal fistulas are abnormal communications between the rectum and vagina. The cause of rectovaginal fistulas are obstetric trauma, inflammatory bowel disease, radiation proctitis, and rectal operations, especially stapled anterior resections. The management of rectovaginal fistulas depends on size, location, cause, anal sphincter function, and health status of the patient. Successful treatment entails excision of the fistula and the interposition of healthy tissue between the rectum and vagina. Surrounding tissue should not be inflamed. Sphincter dysfunctions should also be repaired. The management of simple rectovaginal fistulas, such as those which are low, or small, and secondary to obstetric trauma, may be repaired locally. The endorectal advancement flap or transvaginal layered repair are the methods of choice. When sphincter function is diminished, the external sphincter should be reconstructed. For complex fistulas, such those which are high or large, and recurrent, sphincteroplasty and tissue transposition methods, such as graciloplasty are needed. For disease speciphic fistulas, therapy is determined by the cause of the rectovaginal fistula. In the cases of radiation induced rectovaginal fistulas, the diseased rectum and the sigmoid colon must be resected, and coloanal anastomosis is a satisfactory option. |
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