Surgical Management of Rectovaginal Fistulas
Summary
Rectovaginal fistulas are abnormal communications between the rectum and vagina that may arise from obstetric trauma, inflammatory bowel disease, radiotherapy or surgical complications. They present with faecal or gas passage through the vagina, leading to physical discomfort, sexual dysfunction and marked psychosocial distress. Surgical management aims to restore anatomy and function by excising the fistulous tract, reinforcing tissue planes and, where necessary, diverting the faecal stream. Techniques range from simple local repairs to advanced tissue interposition using vascularised flaps or muscle transposition. Patient selection depends on fistula aetiology, size, location and local tissue health, with diversion by stoma often employed to optimise healing conditions. Multidisciplinary assessment—including colorectal surgery, gynaecology, radiology and sometimes gastroenterology for Crohn’s disease—is essential. Outcome predictors include prior repair history, underlying inflammatory activity and adequacy of tissue interposition, all of which inform the choice between local repair, flap procedures and faecal diversion to maximise long-term closure rates and preserve quality of life.
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Surgical Management of Rectovaginal Fistulas publication trend
The graph below shows the total number of articles in surgical management of rectovaginal fistulas across all publications each year (not limited to Nature Index journals).
Technical terms
Rectovaginal fistula: An abnormal tract between the rectal lumen and vaginal vault permitting passage of faecal material or gas.
Modified Martius flap: A vascularised fat pad from the labia majora transposed to reinforce the rectovaginal septum during repair.
Micro-fragmented adipose tissue (MFAT): Processed fat graft containing stromal vascular fraction used to deliver regenerative cells to repair sites.
Mesenchymal stem cells (MSCs): Multipotent stromal cells capable of modulating inflammation and promoting tissue regeneration.
Diverting stoma: Temporary creation of a proximal faecal diversion (ileostomy or colostomy) to protect a repair and facilitate healing.
References
- Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue. Biomedicines (2023).
- Surgical treatment of rectovaginal fistula—predictors of outcome and effects on quality of life. International Journal of Colorectal Disease (2022).
- Surgical repair of rectovaginal fistulas: predictors of fistula closure. International Urogynecology Journal (2019).
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