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Rectovaginal Fistula

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  • Rectovaginal fistula

    A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Passage of gas, stool or pus from the vagina. Foul-smelling vaginal discharge. Recurrent vaginal or urinary tract infections. Irritation or pain in the vulva, vagina and the area between the vagina and anus (perineum) Pain during sexual intercourse.

  • Rectovaginal fistula

    After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix. A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.

  • Rectovaginal fistula

    Seventy-nine patients presented RVF due to Crohn disease  in 34 (43%), postoperative in 25 (32%), obstetrical in 7 (9%), radiation proctitis in 4 (5%), and miscellaneous in 9 (11%). A total of 286 procedures (132 with associated stoma, 46%) were performed including 217 conservative (76%) [seton drainage (n?=?59; 21%), vaginal (n?=?49, 17%) or rectal advancement flap (n?=?46; 16%), diverting stoma only (n?=?27; 9%), plug (n?=?15; 5%), glue (n?=?13; 5%), or others (n?=?8, 3%)]; and 69 major procedures (24%) [gracilis muscle interposition (n?=?32; 11%), coloanal or colorectal anastomosis (n?=?19; 7%) including 11 delayed anastomosis with colonic pull-through, biomesh interposition (n?=?9, 3%), and abdominoperineal resection (n?=?9; 3%)]. After a mean follow-up of 33 months, overall success rate was 57 of 79 (72%). Per-procedure-based multivariate analysis identified major procedure [odds ratio (OR): 6.4 (2.9–14.2); P?<?0.001], diverting stoma, less than 9 months between diagnosis and first surgery [OR: 2.3, and first surgery in our institution; P?=?0.003], as independent factors for success.

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