Rectovaginal fistula is a very traumatic experience for a woman and can be extremely difficult for the surgeon to treat. It is a connection or tract (fistula) between the rectum and the vagina with passing of flatus and stool through the vagina and often a severe inflammation of the vagina and the entire perineal region.
The cause of rectovaginal fistula is often traumatic (e.g. following surgery) but it also appears after irradiation or as a late complication of an abscess in this area.
The diagnosis is made by clinical examination, rectoscopy and/or injection of ink into the fistula. We differentiate between low and high fistulas, i.e. the lower 1/3 and the upper 2/3 of the vagina.
Treatment depends on the location of the fistula, its cause and its size/extension.
In uncomplicated, low fistulas rectal or vaginal advancement flaps can be used with good results to close the fistula. The patients usually do not need a diverting stoma.
In complicated or high fistulas I always use a diverting stoma, to block the passage of stool. In order to achieve permanent closure of the fistula, the two organs are separated by wide dissection and healthy tissue has to be placed between them. I use a “graciloplasty” for this purpose. The gracilis muscle is a well suited muscle on the inside of the thigh which can be mobilized, preserving its blood supply and transposed to the perineal wound between rectum and vagina. It is fixed there with sutures and facilitates healing of the fistula. The stoma is usually closed after 2 months.