The Noble-Mengert-Fish operation - Revisited: A composite approach for persistent rectovaginal fistulas and complex perineal defects

OBJECTIVE: Our aims were to evaluate the full-thickness anterior rectal wai l advancement flap in the treatment of primary and recurrent or persistent rectovaginal fistulas, evaluate the surgical exposure for composite repair of site-specific perineal defects, and categorize clinical manifestations o f site-specific perineal defects caused by obstetric injury. STUDY DESIGN:This is a prospective study of all patients with fecal inconti nence from rectovaginal septal defects and complex perineal obstetric injur ies treated by the Noble-Mengert-Fish operation. RESULTS: Thirty-four patients were classified into groups on the basis of s ite-specific perineal defects. Anatomic success was 94.2%. Functional succe ss was excellent in 76.5%, good in 14.7%, fair in 5.9%, and poor in 2.9%. CONCLUSION: The Noble-Mengert-Fish operation is effective for primary and r ecurrent or persistent rectovaginal fistulas. The circumanal surgical expos ure permits concomitant repair of all perineal defects.