Skip to main content
SpringerLink
Log in

Management of Ano/Rectovaginal Fistula

  • Chapter
  • First Online:
Mastery of IBD Surgery

  • 517 Accesses

Abstract

Fistulas to the vagina from the anus or low rectum are variously called anovaginal and rectovaginal fistula (RVF) and the latter phrase will be used throughout this chapter. RVF’s are a devastating problem producing severe symptoms in many cases. They occur more commonly in Crohn’s disease than in the general population, with a prevalence of 10% and mean age of onset of 34 years in a series of 886 patients. A population based survey from Minnesota found that 35% of Crohn’s disease patients had fistulas and 9% of these were RVF’s. RVF’s are more commonly associated with colonic (23%) than small bowel (3.5%) Crohn’s disease. A variety of techniques are used in managing Crohn’s disease related RVF’s. In this chapter, the literature pertaining to surgical treatment of an RVF complicating Crohn’s disease is reviewed and is followed by recommendations and opinions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Radcliffe AG, Ritchie JK, Hawley PR, Lennard-Jones JE, Northover JM. Anovaginal and rectovaginal fistulas in Crohn’s disease. Dis Colon Rectum. 1988;31(2):94–9.

    Article  CAS  Google Scholar 

  2. Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122(4):875–80.

    Article  Google Scholar 

  3. Ritchie JK, Lennard-Jones JE. Crohn’s disease of the distal large bowel. Scand J Gastroenterol. 1976;11(5):433–6.

    CAS  PubMed  Google Scholar 

  4. Van Patter WN, Bargen JA, Dockerty MB, Feldman WH, Mayo CW, Waugh JM. Regional enteritis. Gastroenterology. 1954;26(3):347–450.

    Article  Google Scholar 

  5. Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248(1):39–43.

    Article  Google Scholar 

  6. Furst A, Schmidbauer C, Swol-Ben J, Iesalnieks I, Schwandner O, Agha A. Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease. Int J Color Dis. 2008;23(4):349–53.

    Article  Google Scholar 

  7. Ulrich D, Roos J, Jakse G, Pallua N. Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. J Plast Reconstr Aesthet Surg. 2009;62(3):352–6.

    Article  Google Scholar 

  8. Lefevre JH, Bretagnol F, Maggiori L, Alves A, Ferron M, Panis Y. Operative results and quality of life after gracilis muscle transposition for recurrent rectovaginal fistula. Dis Colon Rectum. 2009;52(7):1290–5.

    Article  CAS  Google Scholar 

  9. Rottoli M, Vallicelli C, Boschi L, Cipriani R, Poggioli G. Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistula: is Crohn’s disease a risk factor for failure? A prospective cohort study. Updat Surg. 2018;70(4):485–90.

    Article  Google Scholar 

  10. Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54(12):1537–41.

    Article  Google Scholar 

  11. Nosti PA, Stahl TJ, Sokol AI. Surgical repair of rectovaginal fistulas in patients with Crohn’s disease. Eur J Obstet Gynecol Reprod Biol. 2013;171(1):166–70.

    Article  Google Scholar 

  12. Songne K, Scotte M, Lubrano J, Huet E, Lefebure B, Surlemont Y, et al. Treatment of anovaginal or rectovaginal fistulas with modified Martius graft. Color Dis. 2007;9(7):653–6.

    Article  CAS  Google Scholar 

  13. Pitel S, Lefevre JH, Parc Y, Chafai N, Shields C, Tiret E. Martius advancement flap for low rectovaginal fistula: short- and long-term results. Color Dis. 2011;13(6):e112–5.

    Article  CAS  Google Scholar 

  14. Schwandner O, Fuerst A, Kunstreich K, Scherer R. Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol. 2009;13(2):135–40.

    Article  CAS  Google Scholar 

  15. Mege D, Frasson M, Maggiori L, Panis Y. Is biological mesh interposition a valid option for complex or recurrent rectovaginal fistula? Color Dis. 2016;18(2):O61–5.

    Article  CAS  Google Scholar 

  16. Gajsek U, McArthur DR, Sagar PM. Long-term efficacy of the button fistula plug in the treatment of Ileal pouch-vaginal and Crohn’s-related rectovaginal fistulas. Dis Colon Rectum. 2011;54(8):999–1002.

    Article  CAS  Google Scholar 

  17. Garcia-Arranz M, Herreros MD, Gonzalez-Gomez C, de la Quintana P, Guadalajara H, Georgiev-Hristov T, et al. Treatment of Crohn’s-related rectovaginal fistula with allogeneic expanded-adipose derived stem cells: a phase I-IIa clinical trial. Stem Cells Transl Med. 2016;5(11):1441–6.

    Article  CAS  Google Scholar 

  18. Norderval S, Lundby L, Hougaard H, Buntzen S, Weum S, de Weerd L. Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas. Tech Coloproctol. 2018;22(1):45–51.

    Article  CAS  Google Scholar 

  19. Prosst RL, Joos AK. Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas. Tech Coloproctol. 2016;20(11):753–8.

    Article  CAS  Google Scholar 

  20. Gautier M, Godeberge P, Ganansia R, Bozio G, Godart B, Bigard MA, et al. Easy clip to treat anal fistula tracts: a word of caution. Int J Color Dis. 2015;30(5):621–4.

    Article  CAS  Google Scholar 

  21. Panes JG-OD, Van Assche G., Colombel J.-F., Reinisch W., Baumgart D.C., Nachury M., Ferrante M., Kazemi-Shirazi L., Grimaud J.C., de la Portilla F., Goldin E., Richard M.P., Diez M.C., Danese S., editor Long-term efficacy and safety of Cx601, allogeneic expanded adipose-derived mesenchymal stem cells, for complex perianal fistulas in Crohn’s disease: 52-week results of a phase III randomised controlled trial ECCO; 2017; Barcelona.

    Google Scholar 

  22. Ruffolo C, Penninckx F, Van AG, Vermeire S, Rutgeerts P, Coremans G, et al. Outcome of surgery for rectovaginal fistula due to Crohn’s disease. Br J Surg. 2009;96(10):1190–5.

    Article  CAS  Google Scholar 

  23. Athanasiadis S, Yazigi R, Kohler A, Helmes C. Recovery rates and functional results after repair for rectovaginal fistula in Crohn’s disease: a comparison of different techniques. Int J Color Dis. 2007;22(9):1051–60.

    Article  Google Scholar 

  24. Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C. Repair of recurrent rectovaginal fistulas. Surgery. 2001;130(4):753–7; discussion 7–8

    Article  CAS  Google Scholar 

  25. Loffler T, Welsch T, Muhl S, Hinz U, Schmidt J, Kienle P. Long-term success rate after surgical treatment of anorectal and rectovaginal fistulas in Crohn’s disease. Int J Color Dis. 2009;24(5):521–6.

    Article  Google Scholar 

  26. Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RC, Kamm MA. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003;17(9):1145–51.

    Article  CAS  Google Scholar 

  27. Windsor L, Khan R, Williams N. Rectovaginal fistulae in Crohn’s disease: a management paradox. Color Dis. 2000;2(3):154–8.

    Article  CAS  Google Scholar 

  28. O’Leary DP, Milroy CE, Durdey P. Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl. 1998;80(4):250–2.

    PubMed  PubMed Central  Google Scholar 

  29. El-Gazzaz G, Hull T, Mignanelli E, Hammel J, Gurland B, Zutshi M. Analysis of function and predictors of failure in women undergoing repair of Crohn’s related rectovaginal fistula. J Gastrointest Surg. 2010;14(5):824–9.

    Article  Google Scholar 

  30. Gaertner WB, Madoff RD, Spencer MP, Mellgren A, Goldberg SM, Lowry AC. Results of combined medical and surgical treatment of rectovaginal fistula in Crohn’s disease. Color Dis. 2011;13(6):678–83.

    Article  CAS  Google Scholar 

  31. Penninckx F, Moneghini D, D’Hoore A, Wyndaele J, Coremans G, Rutgeerts P. Success and failure after repair of rectovaginal fistula in Crohn’s disease: analysis of prognostic factors. Color Dis. 2001;3(6):406–11.

    Article  CAS  Google Scholar 

  32. Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg. 2003;90(3):351–4.

    Article  CAS  Google Scholar 

  33. Corte H, Maggiori L, Treton X, Lefevre JH, Ferron M, Panis Y. Rectovaginal fistula: what is the optimal strategy? An analysis of 79 patients undergoing 286 procedures. Ann Surg. 2015;262(5):855–60; discussion 60–1

    Article  Google Scholar 

  34. Sauk J, Nguyen D, Yajnik V, Khalili H, Konijeti G, Hodin R, et al. Natural history of perianal Crohn’s disease after fecal diversion. Inflamm Bowel Dis. 2014;20(12):2260–5.

    Article  Google Scholar 

  35. Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg. 2000;24(10):1258–62; discussion 62–3

    Article  CAS  Google Scholar 

  36. Marti-Gallostra M, Myrelid P, Mortensen N, Keshav S, Travis SP, George B. The role of a defunctioning stoma for colonic and perianal Crohn’s disease in the biological era. Scand J Gastroenterol. 2017;52(3):251–6.

    Article  CAS  Google Scholar 

  37. Mueller MH, Geis M, Glatzle J, Kasparek M, Meile T, Jehle EC, et al. Risk of fecal diversion in complicated perianal Crohn’s disease. J Gastrointest Surg. 2007;11(4):529–37.

    Article  CAS  Google Scholar 

  38. Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg. 2005;241(5):796–801.

    Article  Google Scholar 

  39. Uribe N, Millan M, Minguez M, Ballester C, Asencio F, Sanchiz V, et al. Clinical and manometric results of endorectal advancement flaps for complex anal fistula. Int J Color Dis. 2007;22(3):259–64.

    Article  Google Scholar 

  40. de Parades V, Dahmani Z, Blanchard P, Zeitoun JD, Sultan S, Atienza P. Endorectal advancement flap with muscular plication: a modified technique for rectovaginal fistula repair. Color Dis. 2011;13(8):921–5.

    Article  Google Scholar 

  41. Hull TL, Bartus C, Bast J, Floruta C, Lopez R. Multimedia article. Success of episioproctotomy for cloaca and rectovaginal fistula. Dis Colon Rectum. 2007;50(1):97–101.

    Article  CAS  Google Scholar 

  42. Soriano D, Lemoine A, Laplace C, Deval B, Dessolle L, Darai E, et al. Results of recto-vaginal fistula repair: retrospective analysis of 48 cases. Eur J Obstet Gynecol Reprod Biol. 2001;96(1):75–9.

    Article  CAS  Google Scholar 

  43. Tozer PJ, Balmforth D, Kayani B, Rahbour G, Hart AL, Phillips RK. Surgical management of rectovaginal fistula in a tertiary referral centre: many techniques are needed. Color Dis. 2013;15(7):871–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Robin Phillips Fistula Research Unit, St Mark’s Hospital, London and Imperial College London, London, UK

    Charlene Twum-Barima BSc (Hons), MBChB, MRCS & Phil Tozer BSc (Hons), MBChB, MRCS

Authors
  1. Charlene Twum-Barima BSc (Hons), MBChB, MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phil Tozer BSc (Hons), MBChB, MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Phil Tozer BSc (Hons), MBChB, MRCS .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Twum-Barima, C., Tozer, P. (2019). Management of Ano/Rectovaginal Fistula. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16755-4_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation