Anorectal Fistula in Recurrent Complex Rectovaginal Fistula or Pelvic Radiation-Related Fistula

This protocol addresses anorectal fistula in the specific and challenging setting of recurrent complex rectovaginal fistula (RVF), or RVF that has developed in the context of prior pelvic radiation — situations that require a more definitive surgical approach than primary repairs.

Clinical Scenario

Rectovaginal fistula

Patients present with recurrent, complex rectovaginal fistulas, or rectovaginal fistulas arising in the setting of pelvic radiation. Radiation-related tissue changes and prior failed repairs define this high-complexity sub-population, where standard local approaches are insufficient.

Surgical Approach — Overview

Management in this setting may involve a proctectomy-based strategy to achieve durable resolution, with options for restoring bowel continuity considered at the time of or after resection.

The complete structured regimen — including procedural sequencing and anastomotic options — is available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

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.

In the setting of proctectomy, a primary or staged (ie, Turnbull-Cutait procedure) coloanal anastomosis may be used to restore continuity of the bowel.

View source ↗