Modern opportunities for treatment of patients with rectovaginal fistulas: literature review

Abstract

The review is devoted to the most pressing issues of etiology, classification, diagnosis and treatment of rectovaginal fistulas. The psychosocial impact of a rectovaginal fistula on women’s quality of life cannot be overemphasized. The most common causes of rectovaginal fistula are postoperative and obstetric complications, inflammatory bowel disease, complications of radiation therapy, and neoplasms. A combination of advanced imaging techniques, physical examination, and clinical experience can help determine the location and cause of a fistula. The therapeutic options are varied, but the results are often unsatisfactory. In this regard, the choice of a strategy for the treatment of rectovaginal fistulas should be based on etiology, localization and concomitant pathology. Despite the prevalence and serious consequences of rectovaginal fistulas, there is no generally accepted scientifically based approach to surgical treatment. Collaboration between obstetricians-gynecologists and colorectal surgeons, detailed preoperative assessment, consideration of optimal treatment options and correct surgical technique can achieve a successful outcome in most patients. The aim of the study is to evaluate, on the basis of literature sources, the problem of diagnosis and treatment of patients with rectovaginal fistulas and modern possibilities for improving the results of surgical interventions in this pathology. The methodological basis of the analysis was the study of domestic and foreign literature devoted to this problem. Scientific articles were selected for the period 2016–2021, with the largest randomized controlled trials in this area. The article provides an overview of the main management strategies and technical approaches that are currently effective in eliminating this socially disabling condition.