Techniques for Repair of Recto-vaginal Fistula

Abstract

Acquired recto-vaginal fistulas usually develop as a consequence of trauma, malignancy, inflammatory disease or tissue necrosis. The treatment of the fistula depends, therefore, on the underlying pathology. Recto-vaginal fistula due to carcinoma of the rectum, vagina or cervix clearly requires radical surgical treatment for the carcinoma and if this is not possible, a defunctioning colostomy to save the patient from the distressing consequence of uncontrollable leakage of faeces per vaginam. The treatment of fistulas due to an inflammatory bowel disease (usually Crohn’s disease) must be also directed mainly at the primary pathology. If there is untreated active disease attempts at conservative repair of any associated rectovaginal fistula are almost always doomed to failure. It is a good general rule that if the primary inflammatory pathology is Crohn's disease even the most innocent-looking fistula should always be left alone until the primary bowel disease has been controlled [18].