Rectovaginal Fistula: What to Do When Nonoperative Management Fails to Resolve Acute Inflammation and Infection

This protocol applies when a patient with rectovaginal fistula has undergone a course of nonoperative measures — lasting up to 3 to 6 months — without achieving resolution of acute inflammation and infection, and escalation to the next treatment step is indicated.

Prior Therapy — Failure Condition

Nonoperative management — including baths, wound care, debridement as needed, antibiotics in cases of infection, and stool-bulking fiber supplements — was pursued for a period usually of 3 to 6 months. The defined goal of resolving acute inflammation and infection was not reached, triggering escalation to the next line of management.

Next-Step Approach

The evidence-based protocol for this situation involves a surgical drainage procedure intended to relieve active inflammation, edema, and infection — creating the conditions needed before any subsequent definitive repair can be considered.

Full procedural details, candidate selection criteria, and the complete management algorithm are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

A draining seton may facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas.

In patients who are considered candidates for definitive repair, draining setons may relieve acute inflammation, edema, and infection and may improve the likelihood of success of subsequent definitive fistula repair.

DOI: 10.1097/DCR.0000000000002473

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