Reconstruction of rectovaginal fistula with sphincter disruption by combining rectal mucosal advancement flap and anal sphincteroplasty

PURPOSE: This study evaluated the effectiveness of combining advancement fl ap with sphincteroplasty in patients symptomatic with rectovaginal fistula and anal sphincter disruption. METHODS: Twenty patients with rectovaginal f istulas and anal sphincter disruptions after vaginal deliveries underwent c ombined rectal mucosal advancement flap and anal sphincteroplasty between J uly 1986 and July 1993. The mean age of the patients was 30 (range, 18-40) years and the mean duration of symptoms was 54.8 weeks (range, 7 weeks to 6 years). In addition to mucosal advancement nap repair, 13 patients underwe nt two-layer repair of anal sphincters (with reapproximation of the puborec talis in 8 of the patients); 6 patients underwent one-layer overlap repair of anal sphincters (with reapproximation of the puborectalis in 2 of the pa tients); and 1 patient underwent reapproximation of internal anal sphincter alone because squeeze pressures were adequate, as determined by anal manom etry. RESULTS: Postoperatively, vaginal discharge of stool and flatus was e liminated entirely in all 20 patients. Perfect anal continence of stool and flatus was restored in 14 patients (70 percent). Incontinence was improved but not eliminated in six patients (4 incontinent to liquid stool and 2 to flatus), and two patients required perineal pads. Subjectively, 19 patient s (95 percent) reported the result as excellent or good. There were no comp lications. CONCLUSION: The combination of mucosal advancement flap and anal sphincteroplasty is a safe and highly effective procedure for correcting r ectovaginal fistula with sphincter disruption after obstetrical injuries.