Transverse transperineal repair of rectovaginal fistulas in lower vagina

Abstract

The management of a rectovaginal fistula is a significant challenge for the patient and the surgeon, with many acceptable surgical techniques for repair. The transverse transperineal repair is a method that preserves an intact external anal sphincter, allows wide mobilization of rectal and vaginal tissues, and closes the fistula with at least five layers of tissue. We have used this technique in patients with rectovaginal fistulas in the lower vagina for the past several years and recently reviewed our results. A chart review of 21 patients who had a transverse transperineal repair of a rectovaginal fistula in the lower vagina in our institutions from 1983 to 1990 was performed. All patients had a satisfactory recovery with no recurrence of a fistula during a follow-up period ranging from 3 months to 8 years (mean 18 months). The series includes seven patients with Crohn's disease and/or previous failed repairs. Our experience suggests this method provides excellent anatomic and physiologic results with minimal morbidity.