Treatment of Rectovaginal Fistula in Radiation-Related or Recurrent Complex Disease

Radiation-related and recurrent complex rectovaginal fistulas represent particularly challenging presentations. These cases require surgical strategies beyond standard repair, with the goal of achieving complete fistula healing.

Clinical Scenario

This protocol applies to patients with a rectovaginal fistula arising in the setting of prior pelvic radiation, or those with a recurrent or complex rectovaginal fistula where simpler approaches have not been sufficient.

Surgical Approach (Partial Overview)

Management in this setting may involve interposition of vascularised tissue or more extensive rectal resection — the specific technique and reconstructive strategy depend on individual factors detailed in the full protocol.

Full procedural options, decision criteria, and sequencing are in the complete protocol.

Treatment Goal

Healing of the rectovaginal fistula.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/DCR.0000000000002473

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.

Completion proctectomy with or without colonic pull-through or coloanal anastomosis may be required to treat radiation-related or recurrent complex rectovaginal fistula.

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