Rectovaginal Fistula Guidelines

Updated: Jul 29, 2022
  • Author: Dana Taylor, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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ASCRS Guidelines for Rectovaginal Fistula

In August 2022, the American Society of Colon and Rectal Surgeons (ASCRS) published guidelines on the management of rectovaginal fistula (RVF), [19]  which included the following recommendations:

  • Nonoperative management is typically recommended for the initial care of obstetrical rectovaginal fistula and may also be considered for other benign and minimally symptomatic fistulas.
  • A draining seton may facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas.
  • Endorectal advancement flap with or without sphincteroplasty is the procedure of choice for most patients with a rectovaginal fistula.
  • Episioproctotomy may be used to repair obstetrical or cryptoglandular rectovaginal fistulas in patients with anal sphincter defects.
  • A gracilis muscle or bulbocavernosus (Martius) flap is typically recommended for recurrent or otherwise complex rectovaginal fistula.
  • Rectovaginal fistulas that result from colorectal anastomotic complications often require a transabdominal approach for repair.
  • Completion proctectomy with or without colonic pull-through or coloanal anastomosis may be required to treat radiation-related or recurrent complex rectovaginal fistula.