12: Repair of rectovaginal fistula, external anal sphincteroplasty, and perineorrhaphy

Abstract

To describe and demonstrate the surgical technique for repair of distal rectovaginal fistula, with concomitant external anal sphincteroplasty, and perineorrhaphy. The patient is a 29 year old G1P1 who underwent a spontaneous vaginal delivery complicated by a fourth degree perineal laceration three weeks prior. This was repaired at the time of delivery. She presented with symptoms of fecal urgency and flatal incontinence. On exam, she was noted to have a large anterior external anal sphincter defect, attenuated perineal body, and a 2 mm rectovaginal fistula 1 cm proximal the external anal sphincter complex. Repair of distal rectovaginal fistula can be accomplished at the time of external anal sphincteroplasty and perineirrhaphy, utilizing the same perineal incision.