OPERATIVE REPAIR OF ANOVAGINAL AND RECTOVAGINAL FISTULAS

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.