Contemporary surgical management of rectovaginal fistula in Crohn's disease

Figure 2 Rectal sleeve advancement flap. A: Dissection begins at the dentate line with a 90%-100% circumferential mucosectomy of ulcerated mucosa and submucosa of the anal canal and is carried cephalad until the supralevator space is breeched. After sufficient rectal mobilization has been accomplished, the fistula tract is cored out and then closed with absorbable suture and the vaginal mucosa is left open; B: The diseased distal margin of tissue is trimmed and the cuff of rectum is advanced down and sutured to the ridge of anoderm using absorbable sutures. Reprinted with permission, Cleveland Clinic Center for Medical Art and Photography © 1999-2014. All Rights Reserved.