This protocol covers the management of rectovaginal fistula in patients who have already undergone an initial seton procedure but have not yet achieved the prerequisite resolution of acute inflammation, edema, and infection required before definitive repair can safely proceed.
A draining seton was placed as the first step, with the goal of relieving acute inflammation, edema, and infection associated with the fistula. When relief of these conditions is not achieved, escalation to the next treatment line is indicated.
The next step involves a definitive surgical flap-based repair approach, which may be combined with additional sphincter repair depending on the clinical findings. The complete procedural algorithm is available in the full protocol.
Healing of the rectovaginal fistula.
Endorectal advancement flap with or without sphincteroplasty is the procedure of choice for most patients with a rectovaginal fistula.
DOI: 10.1097/DCR.0000000000002473
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