Rectovaginal Fistula: Next-Line Management When Endorectal Advancement Flap Did Not Achieve Healing

Rectovaginal fistula is an abnormal communication between the rectum and vagina. For most patients, endorectal advancement flap — with or without sphincteroplasty — is the procedure of choice. When that approach fails to achieve fistula healing, a defined next-line surgical strategy applies.

Prior treatment and reason for escalation

The previous intervention — endorectal advancement flap with or without sphincteroplasty — did not achieve the primary goal: healing of the rectovaginal fistula. This failure, in the setting of a recurrent or otherwise complex fistula, is the indication for proceeding to the next surgical line.

Next-line approach (partial overview)

Management at this stage involves a muscle flap-based reconstructive technique, typically combined with an additional adjunctive procedure to support repair. The full surgical algorithm — including the specific flap options and the role of the adjunct — is detailed in the complete protocol.

Treatment goal

Healing of the rectovaginal fistula.

Instant Access to Structured Evidence-Based Regimens

References

A gracilis muscle or bulbocavernosus (Martius) flap is typically recommended for recurrent or otherwise complex rectovaginal fistula.

Although supporting evidence is lacking, a diverting ostomy is generally recommended as an adjunct to Martius and gracilis muscle flap repairs.

DOI: 10.1097/DCR.0000000000002473

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