PURPOSE: Operative repair of low rectovaginal fistulas should be tailo
red to the specific anatomic defect. Endoanal flap repair frequently p
rovides successful fistula closure; however, if substantial injury to
the perineal body, anal sphincter, or rectovaginal septum exists, a mo
re extensive repair is required. We present our experience with 95 con
secutive patients, operated for rectovaginal fistulas via septal repai
r after conversion to a fourth degree perineal laceration, endoanal fl
ap, or anoperineorrhaphy. METHODS: A retrospective chart review was pe
rformed. Data collected included etiology, location, size, repair type
, and degree of anal continence. All patients received standard mechan
ical and antibiotic bowel preparation and parenteral antibiotics. No c
overing stomas were used. RESULTS: Fistula etiology included obstetric
injury (N = 77), perianal cryptoglandular infection (N = 15), and oth
er (N = 3). Thirty-one patients had previous unsuccessful repairs. Typ
es of repairs were fourth degree perineal laceration (38), endoanal fl
ap (19), and anoperineorrhaphy (38). Excellent or good functional resu
lts occurred in 92 patients (97 percent). Similar success occurred in
patients with previous failed repairs (90 percent excellent or good).
The recurrence rate was 3 percent. There were no outcome differences b
etween techniques. CONCLUSION: We believe that all three types of repa
ir for rectovaginal fistulas result in a high cure rate, thereby allow
ing operative technique to be tailored to the anatomic defects present
. This approach should allow for optimal functional outcome.