Rectovaginal Fistula Guidelines

Updated: Mar 22, 2021
  • Author: Dana Taylor, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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ASCRS Clinical Practice Guideline

In 2016, the American Society of Colon and Rectal Surgeons (ASCRS) published the following guidelines on the management of rectovaginal fistula (RVF) [19] :

  • Nonoperative management is recommended for initial management of obstetrical RVF; it may also be considered for other benign and minimally symptomatic fistulas (weak recommendation; level of evidence, 2C)
  • A draining seton may be needed to facilitate resolution of acute inflammation or infection associated with an RVF (strong recommendation; level of evidence, 1C)
  • An endorectal advancement flap, with or without sphincteroplasty, is the procedure of choice for most simple RVFs (strong recommendation; level of evidence, 1C)
  • An episioproctotomy may be performed to repair obstetrical or cryptoglandular RVFs associated with extensive anal sphincter damage (strong recommendation; level of evidence, 1C)
  • A gracilis muscle or bulbocavernosus muscle (Martius) flap is recommended for a recurrent or otherwise complex RVF (strong recommendation; level of evidence, 1C)
  • A high RVF resulting from complications of a colorectal anastomosis often requires an abdominal approach for repair (strong recommendation; level of evidence, 1C)
  • Proctectomy with colon pullthrough or coloanal anastomosis may be necessary to repair a radiation-related or recurrent complex RVF (weak recommendation; level of evidence, 2C)