Rectovaginal fistula arising as a complication of colorectal anastomosis presents a challenging surgical problem. These fistulas often require a transabdominal approach for repair, and achieving complete healing may require more than the initial management step.
Initial management — fecal diversion to facilitate resolution of acute inflammation and associated symptoms, and in selected cases early reoperation with repeat colorectal anastomosis — aims to heal the fistula and restore normal function. When the fistula persists and those goals remain unmet, escalation to the next management step is indicated. This protocol addresses that situation.
For a persistent fistula, the next step involves direct surgical repair of the fistula tract using one of several reconstructive operative strategies. Which approach is appropriate depends on factors detailed in the complete protocol.