Rectovaginal fistula is an abnormal communication between the rectum and vagina. Before any surgical consideration, first-line management is conservative and nonoperative, focused on optimising the local tissue environment over a defined observation period.
The clinical priority in initial management is resolution of acute inflammation and infection. This must be achieved before further decisions about the fistula can be made.
Resolution of acute inflammation & infectionManagement is nonoperative and typically sustained over a period of several months. It combines local wound-directed measures with supportive interventions targeting the infectious and inflammatory components — the complete regimen, decision criteria, and escalation pathway are contained in the full protocol.
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.
In most cases, the initial management of RVFs, especially those of obstetric cause, is nonoperative and may include baths, wound care, debridement as needed, antibiotics in cases of infection, and stool-bulking fiber supplements for a period usually of 3 to 6 months.
The aim of this approach is to resolve acute inflammation and infection.
DOI: 10.1097/DCR.0000000000002473
View source ↗