Skip to main content

Anovaginal and Rectovaginal Fistula

  • Chapter
Anorectal Disease

Abstract

Rectovaginal fistulas (RVFs) or anovaginal fistulas (AVFs) are disabling and difficult conditions to treat. There is an array of various surgical techniques available for repair ranging from local repair, muscle flaps, and transabdominal approaches to resections. The success and complications vary based on the procedure utilized. The aim of this chapter is to review the anatomy and pathology of RVFs and AVFs and to review the past and current surgical techniques.

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

Access this chapter

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. Rivadeneira DE, Ruffo B, Amrani S, Salinas C. Rectovaginal fistulas: current surgical management. Clin Colon Rectal Surg. 2007;20:96–101.

    Article  PubMed Central  PubMed  Google Scholar 

  2. El-Gazzaz G, Hull TL, Mignanelli E, Hammel J, Gurland B, Zutshi M. Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function. J Gastrointest Surg. 2010;14:1758–63.

    Article  PubMed  Google Scholar 

  3. Venkatesh KS, Ramanujam PS, Larson DM, et al. Anorectal complications of vaginal delivery. Dis Colon Rectum. 1989;32:1039–41.

    Article  CAS  PubMed  Google Scholar 

  4. Bahadursingh Am LW. Colovaginal fistulas. Etiology and management. J Reprod Med. 2003;48(7):489–95.

    PubMed  Google Scholar 

  5. Tsang CB, Rothenberger DA. Rectovaginal fistulas. Therapeutic options. Surg Clin North Am. 1997;77:95–114.

    Article  CAS  PubMed  Google Scholar 

  6. deBeche-Adams TH, Bohl JL. Rectovaginal fistulas. Clin Colon Rectal Surg. 2010;23(2):99–103.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ozuner G, Hull TL, Cartmill J, et al. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum. 1996;39:10–4.

    Article  CAS  PubMed  Google Scholar 

  8. Lowry AC, Thorson AG, Rothengerger DA, et al. Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum. 1988;31:676–8.

    Article  CAS  PubMed  Google Scholar 

  9. MacRae HM, McLeod RS, Cohen Z, et al. Treatment of rectovaginal fistulas that has failed previous repair attempts. Dis Colon Rectum. 1995;38:921–5.

    Article  CAS  PubMed  Google Scholar 

  10. Pinto RA, Peterson TV, Shawki S, DaSilva GW, Wexner SD. Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum. 2010;53:1240–7.

    Article  PubMed  Google Scholar 

  11. Watson SJ, Phillips RK. Non-inflammatory rectovaginal fistula. Br J Surg. 1995;82:1641–3.

    Article  CAS  PubMed  Google Scholar 

  12. Vasilevsky C, Gordon PH. The incidence of recurrent abscesses for fistula-in-ano following anorectal suppuration. Dis Colon Rectum. 1984;27:126.

    Article  CAS  PubMed  Google Scholar 

  13. The Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of fistula-in-ano. Dis Colon Rectum. 1996;39:1361.

    Google Scholar 

  14. Kuijpers HC, Schulpen T. Fistulography for fistula-in-ano: is it useful? Dis Colon Rectum. 1985;28:103.

    Article  CAS  PubMed  Google Scholar 

  15. Cheong DM, Nogueras JJ, Wexner SD, Jagelman DG. Anal endosonography for recurrent anal fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum. 1993;36:1158.

    Article  CAS  PubMed  Google Scholar 

  16. Sabir N, Sungurtekin U, Erdem E, Nessar M. Magnetic resonance imaging with rectal Gd-DTPA: new tool for the diagnosis of perianal fistula. Int J Colorectal Dis. 2000;15:317.

    Article  CAS  PubMed  Google Scholar 

  17. Lunniss PJ, Armstrong P, Barker PG, et al. Magnetic resonance imaging of anal fistulae. Lancet. 1992;340:394.

    Article  CAS  PubMed  Google Scholar 

  18. Barker PG, Lunniss PJ, Armstrong P, et al. Magnetic resonance imaging of fistula-in-ano: technique, interpretation, and accuracy. Clin Radiol. 1992;49:7.

    Article  Google Scholar 

  19. Ruffolo C, Penninckx F, Van AG. Outcome of surgery for rectovaginal fistula due to Crohn’s disease. Br J Surg. 2009;96:1190–5.

    Article  CAS  PubMed  Google Scholar 

  20. Stone JM, Goldberg SM. The endorectal advancement flap procedure. Int J Colorectal Dis. 1990;5(4):232–5.

    Article  CAS  PubMed  Google Scholar 

  21. Abbass MA, Lemus-Rangel R, Hamadani A. Long-term outcome of endorectal advancement flap for complex anorectal fistulae. Am Surg. 2008;74(10):921–4.

    Google Scholar 

  22. 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. Colorectal Dis. 2001;3:406–11.

    Article  CAS  PubMed  Google Scholar 

  23. Chew SS, Rieger NA. Transperineal repair of obstetric-related anovaginal fistulas. Aust N Z J Obstet Gynaecol. 2004;44(1):68–71.

    Article  PubMed  Google Scholar 

  24. Hull TL, El-Gazzaz G, Gurland B, Church J, Zutshi M. Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin. Dis Colon Rectum. 2011;54:54–9.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  26. Ellis CN. Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum. 2008;51(7):1084–8.

    Article  PubMed  Google Scholar 

  27. Thekkinkattil DK, Botterill I, Ambrose NS, Lundby L, Sager PM, Finan PJ. Efficacy of the anal fistula plug in complex anorectal fistulae. Colorectal Dis. 2009;11(6):584–7.

    Article  CAS  PubMed  Google Scholar 

  28. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Koder IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum. 2004;47:432–6.

    Article  PubMed  Google Scholar 

  29. Abel ME, Chiu YS, Russell TR, Volpe PA. Autologous fibrin glue in the treatment of rectovaginal and complex fistulas. Dis Colon Rectum. 1993;36:447–9.

    Article  CAS  PubMed  Google Scholar 

  30. Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for the treatment of severe perianal Crohn’s disease. Br J Surg. 1998;85(12):1695–8.

    Article  CAS  PubMed  Google Scholar 

  31. Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C. Repair of recurrent rectovaginal fistulas. Surgery. 2001;130(4):757–8.

    Article  Google Scholar 

  32. Remzi F, El-Gazzaz G, Kiran RP, Kirat HT, Fazio VW. Outcomes following Turnbull-Cutait abdominoperineal pull-through compare with coloanal anastomosis. Br J Surg. 2009;96(4):424–9.

    Article  CAS  PubMed  Google Scholar 

  33. van der Hagen SJ, Soeters PB, Baeten CG, van Gemert WG. Laparoscopic fistula excision and omentoplasty for high rectovaginal fistulas: a prospective study of 40 patients. Int J Colorectal Dis. 2011;26(11):1463–7.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Schwenk W, Böhm B, Grundel K, Muller J. Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty. Surg Endosc. 1997;11:147–9.

    Article  CAS  PubMed  Google Scholar 

  35. Pelosi III MA, Pelosi MA. Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization. J Laparoendosc Adv Surg Tech A. 1997;7:379–83.

    Article  PubMed  Google Scholar 

  36. Kumaran SS, Palanivelu C, Kavalakat AJ, Parthasarathi R, Neelayathatchi M. Laparoscopic repair of high rectovaginal fistula: is it technically feasible. BMC Surg. 2005;5:20.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Troja A, Käse P, El-Sourani N, Raab HR, Antolovic D. Treatment of recurrent rectovaginal/pouch-vaginal fistulas by gracilis muscle transposition-a single center experience. J Visc Surg. 2013;150(6):379–82.

    Article  CAS  PubMed  Google Scholar 

  38. White AJ, Buchsbaum HJ, Blythe JG, Liftshitz S. Use of the bulbocavernosus muscle (Martius procedure) for repair of radiation-induced rectovaginal fistulas. Obstet Gynecol. 1982;60:114–8.

    CAS  PubMed  Google Scholar 

  39. Aartsen EJ, Sindram IS. Repair of the radiation induced rectovaginal fistulas without or with interposition of the bulbocavernosus muscle (Martius procedure). Eur J Surg. 1988;14:171–7.

    CAS  Google Scholar 

  40. Gottgens KW, Heemskerk J, van Gemert W, Smeets R, Stassen LP, Beets G, Baeten CG, Breukink SO. Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh. Tech Coloproctol. 2014;18(9):817–23.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brooke Gurland MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Carchman, E., Gurland, B. (2016). Anovaginal and Rectovaginal Fistula. In: Zutshi, M. (eds) Anorectal Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-23147-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23147-1_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23146-4

  • Online ISBN: 978-3-319-23147-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics