This protocol addresses patients with a rectovaginal fistula of obstetric, cryptoglandular, or other benign and minimally symptomatic origin in whom initial conservative treatment has not achieved the expected clinical goal.
Nonoperative management — including sitz baths, wound care, debridement as needed, and stool-bulking fiber supplements (typically continued for 3–6 months) — failed to achieve resolution of acute inflammation and infection. This failure is the trigger for the current protocol.
When acute inflammation or infection persists despite conservative measures, a surgical drainage procedure is among the interventions that may be employed. The full sequencing and technical details are in the complete protocol.
DOI: 10.1097/DCR.0000000000002473
Nonoperative management is typically recommended for the initial care of obstetrical rectovaginal fistula and may also be considered for other benign and minimally symptomatic fistulas.
A draining seton may facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas.
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