Treatment of Anorectal Fistula in Recurrent Complex Rectovaginal Fistula or Pelvic Radiation–Associated Rectovaginal Fistula
Recurrent or radiation-associated rectovaginal fistulas represent a particularly challenging subset of anorectal fistula. These cases often require a more extensive surgical strategy than primary repairs.
Clinical Scenario
This protocol applies to patients with a recurrent complex rectovaginal fistula, or a rectovaginal fistula developing in the setting of pelvic radiation. Both situations are associated with compromised tissue quality and higher failure rates with standard repair techniques, and may require consideration of more involved reconstructive approaches, including proctectomy.
Surgical Approach — Partial Overview
In this setting, repair may be approached with muscle flap interposition — using vascularised tissue such as a gracilis or bulbocavernosus (Martius) flap — as one component of the surgical strategy. The complete protocol specifies the full range of options, selection criteria, and procedural algorithm.
References
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DOI: 10.1097/DCR.0000000000002473
- Completion proctectomy with or without colonic pull-through or coloanal anastomosis may be required to treat radiation-related or recurrent complex rectovaginal fistula.
- Recurrent, complex RVFs and fistulas that develop in the setting of pelvic radiation may be amenable to repair with a muscle flap interposition as described previously or proctectomy with primary or staged coloanal anastomosis.
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