Simple rectovaginal fistulas

In regard to the causes of simple rectovaginal fistulas (RVF) we examined t he methods of diagnosis and the efficacy and outcome of surgical procedures . The study included all of our patients diagnosed with simple RVF between December 1988 and July 1998 (n=19). Medical charts of these patients were r eviewed regarding diagnostic investigations, operative procedure, outcome, and follow-up. The most common cause was obstetric trauma (n=15, 79%) follo wed by infection (n=4, 21%). Eight patients (42%) had undergone anal surger y prior to the development of RVF; two of these had undergone more than one procedure. Endoanal ultrasound was performed in 15 patients and identified the fistula in 11 (73%). A concomitant sphincter injury was visualized in 9 of 15 patients (60%). The most common initial operation performed was an endoanal advancement flap in 12 patients (63%). This operation was performe d in combination with a sphincteroplasty in 4 patients, while 3 had sphinct eroplasty alone. The mean hospital stay was 3 days (range 1-5). Postoperati ve morbidity was noted in 5 patients (26%) of and consisted of recurrent fi stula and passage of gas per vagina. Surgery was successful in complete res olution of symptoms in 14 cases (74%). Two of the three recurrences were su ccessfully repaired with a repeat endoanal advancement flap, and one is awa iting repair. The mean follow-up for the entire group was 35.8 months (rang e 6-84). Endoanal advancement flap should be the initial treatment of choic e for simple, low rectovaginal fistulas. The procedure can also be employed with expectations of success even after a failed primary repair and should be combined with a sphincteroplasty if a coexistent anteriorly based anal sphincter defect is noted either by clinical examination or endoanal ultras onography.