Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2015; 7(8): 133-137
Published online Aug 27, 2015. doi: 10.4240/wjgs.v7.i8.133
Operative considerations for rectovaginal fistulas
Kevin R Kniery, Eric K Johnson, Scott R Steele
Kevin R Kniery, Eric K Johnson, Scott R Steele, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, Tacoma, WA 98431, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: The authors do not have any conflicts-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Kevin R Kniery, MD, General Surgery Resident, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, United States.
Telephone: +1-504-6554276
Received: April 29, 2015
Peer-review started: April 29, 2015
First decision: May 14, 2015
Revised: May 26, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 27, 2015
Core Tip

Core tip: There are general principles that will allow the best chance for resolution of a rectovaginal fistula with the least morbidity to the patient. Identifying and addressing the disease process that caused the fistula is critical, including medical management for Crohn’s, and resolving inflammation or sepsis with a seton. Then the exact anatomy of the fistula should be defined to determine operative approaches. The operative algorithm should begin with fistula plugs and local advancement flaps, if these fail more invasive options such as diversion, and interposition of healthy tissue should be pursued for complex and recurrent fistulas.