Abstract
The goal of our video is to demonstrate a novel surgical technique for repairing a complex rectovaginal fistula after breakdown of a 4th degree laceration repair. Rectovaginal fistula is rare in the United States with most occurring due to obstetrical trauma. Fortunately, only 1.7 % of deliveries lead to 4th degree lacerations and only 0.5% of those develop into fistulae. These are fistulae are often large and can lead to stool in the vagina and severely decreased quality of life. Scar tissue around the area of the fistula makes it challenging to identify the planes of tissue and demarcate vaginal mucosa from rectal mucosa and sphincter muscle. We utilized a novel method of closure of a complex rectovaginal fistula that included (1) identifying and separating vaginal and rectal tissue, (2) closure of the rectal mucosa and sphincter, (3) dissecting and closing the vaginal tissues in layers (4) completing the closure in the method of a 2nd degree laceration repair. This video illustrates a novel method of repairing a large rectovaginal fistula after breakdown of a 4th degree laceration repair.
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