Treatment of Anorectal Fistula in Rectovaginal Fistula of Obstetric, Cryptoglandular, or Benign Minimally Symptomatic Origin

This protocol addresses anorectal fistula presenting as a rectovaginal fistula arising from obstetric injury, cryptoglandular disease, or a benign and minimally symptomatic cause. The origin of the fistula directly informs the appropriate management pathway.

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. When surgical intervention becomes necessary — such as for recurrent or complex presentations — a structured, evidence-based approach guides the choice of repair strategy.

Surgical management of complex or recurrent rectovaginal fistula in this setting involves a muscle flap reconstruction technique, with a potential adjunctive diverting procedure considered as part of the repair strategy.