Clinical and functional results after tailored surgery for rectovaginal fistula

Recto-vaginal fistulae (RVF) are complex fistulae particularly difficult to treat. Their frequency is relatively low, representing less then 5% of anorectal fistulae.1 Obstetric injury is by far the most frequently reported cause of low recto-vaginal fistulae.2-5 The outcome after surgery for RVF has been correlated with aetiology, complexity of disease, sphincter function and prior attempts to repair.6 The type of operation to correct the fistula may be a fistulotomy or an endorectal advancement flap (EAF) in case of simple fistulae.7 Often, to repair concomitant sphincter defects or to interpose vascularized tissue a sphincteroplasty or a muscle flap is needed.8 More rarely transabdominal resection with an omentoplasty or a coloanal anastomosis is required.9 Because of the diversity of the approach the majority of articles found in the literature deal with a single procedure and often do not include results on anal continence. The aim of the present study was to evaluate the outcome of surgery after a variety of procedures, assessing both healing of the fistula and anal continence.