Management of Postpartum Rectovestibular Fistula with Vaginal and Rectal Mucosal Advancement Flap

Abstract

Women with acquired rectovestibular fistula following obstetric injuries were treated with excision of fistulous tract and reconstruction by a different technique. Four women with acquired rectovestibular fistula underwent excision of fistulous tract and the resulting defect was repaired. The resulting muscular defect was closed, posterior vaginal wall mobilised and sutured to cover the vestibular aspect of the fistula, and the anterior rectal wall was mobilised and sutured to cover the rectal aspect of the fistula. The combined advancement of rectal and vaginal mucosa provides sound protection to the sutured muscle defect in the fistulous area both on the vestibular and rectal sides, thus preventing recurrence. In spite of fewer number of patients, follow-up for five years have shown no recurrence following this novel procedure in women with postpartum H-type of rectovestibular fistula. Though rectal mucosal advancement has been well documented, the addition of vaginal mucosal advancement is emphasised to prevent recurrence.