Reoperative surgery for rectovaginal fistula

This chapter outlines the method of clinical diagnosis of rectovaginal fistulae along with the algorithmic approach to their repair using transvaginal, endorectal, transperineal, or abdominal approaches. This decision is dependent upon the level of the fistula and its etiology. The role of proximal diversion and its risk factors are discussed. Several causes may account for the development of rectovaginal fistula, ranging from simple cryptoglandular disease to iatrogenic injury, perineal trauma, Crohn’s disease, malignancy, and radiation therapy, and the underlying etiology is the single most important factor in fluencing the chance of successful surgical repair. Nearly all types of surgical repair for rectovaginal fistula may also be considered as second-line options in cases of failure of the initial repair.