Transanal advancement of the anterior rectal wall for vaginal fistulas involving the lower rectum

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Abstract
Experience from a personal series of 9 patients with anovaginal or low rectovaginal fistula, operated upon by what is known as the Noble-Elting-Laird technique, is presented. Extensive preoperative mechanical bowel preparation including antibiotics was unnecessary, as was a diverting colostomy. There were no operative deaths. Fistula did not recur in any of the 9 patients followed 6 mo., nor in any of 8 of the 9 patients followed over a period of 2-20 yr. On comparing patients with anovaginal and rectovaginal fistula treated by transanal advancement of the anterior rectal wall with those patients treated by local layer closure, vaginally or anally, transanal advancement of the anterior rectal wall seems to be the better choice, particularly for the patient with a recurrent fistula. Since the anorectum is the primary source of such vaginal fistulas, the condition is probably best approached and treated accordingly.

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