Transanal rectovaginal fistula repair

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Abstract
In this update, 15 additional successful transanal repairs followed for 1-6 yr postoperatively for low rectovaginal fistulas without colostomies are added to the uniformly successful 20 patients presented in a 1978 report. Changes in perioperative routines have greatly enhanced cost efficiency and these modifications are enumerated. The repair still encompasses total excision of the epithelialized fistula and reapproximation of the attenuated septal fibers and anal sphincter mechanism, as well as the caudad rectal mucosal advancement that covers and protects the repair from the fecal stream and the high intraluminal pressures of defecation. Inflammatory, neoplastic and irradiation-caused fistulas have been excluded from this discussion, although this technique has been applied in selected cases.

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