Materiały źródłowe

• #1 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  Treatment is often effective in repairing a rectovaginal fistula and relieving the symptoms. Treatment for the fistula depends on its cause, size, location and effect on surrounding tissues. […] A surgeon may place a silk or latex string, called a draining seton, into the fistula to help drain any infection. This allows the tunnel to heal. This procedure may be combined with surgery. […] In most cases, surgery is needed to close or repair a rectovaginal fistula. Before an operation can be done, the skin and other tissue around the fistula should be free of infection or inflammation. […] Surgery to close a fistula may be done by a gynecological surgeon, a colorectal surgeon or both working as a team. The goal is to remove the fistula tunnel and close the opening by sewing together healthy tissue.

• #2 Rectovaginal Fistula: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22260-rectovaginal-fistula

  Most women have a complete recovery after rectovaginal fistula repair surgery to close the fistula. […] Most women with rectovaginal fistulas need surgery to close the opening. Your healthcare provider may use your tissue or lab-made tissue to repair a rectovaginal fistula. As many as 9 in 10 women recover completely after surgery. […] These steps can aid your recovery after rectovaginal fistula repair surgery: Take antibiotics as prescribed to lower infection risk. Don’t have sex, use tampons or douche until your healthcare provider gives the OK. Prevent constipation and diarrhea (which can cause infection) by eating a healthy, high-fiber diet and drinking plenty of water. Use laxatives or stool softeners as directed by your healthcare provider. […] Rectovaginal fistula repair surgery is highly successful at closing the fistula and putting an end to uncomfortable symptoms.

• #3 Treatment of Rectovaginal Fistula

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10129357/

  Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. With insufficient clinical data due to the rare entity, the present state of treatments for RVFs was reviewed especially from the point of factors to determine management, classifications, principle of treatment, conservative and surgical treatments with outcomes. […] The inflammation should initially subside in cases with infection. Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. […] Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period. […] Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient’s pain.

• #4 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK535350/

  The Conservative or non-surgical treatment approach of the symptoms and possible complications like UTI, local irritation, and site infection can be used in selected patients. This approach can be considered in high-risk patients and severe underlying disease. Medical treatment includes treating the infection and the associated symptoms, maximizing medical treatment of the underlying disease like in Crohn disease or diverticulitis, and supporting the general patient’s condition. Other conservative treatment includes non-operative measures to close the fistula like fibrin glue or other occlusive measures. The success rate of these measures is not high. They are still an option to consider in high-risk patients who are not fit for surgery or failed a prior surgical approach. […] Multiple operative approaches are used to treat RVF depending on complexity, recurrence, and the underlying disease. Simple measures like draining seton in recurrent or acute infection may be used to optimize local tissue integrity and treat the infection. The proximity of the rectal wall to the vaginal wall with minimal tissue makes repairs connecting fistula challenging. The principles of successful repair are to remove the unhealthy fistula tissue, replace with healthy tissue that has a good blood supply to enhance healing, and maintain thick interposing tissue between the rectal and vaginal walls. Following these principles (although not always possible) increase the chance of successful fistula treatment. Fistula debridement and flaps are common surgical approaches. Advancement local endo-rectal flaps in simple RVF or gracilis regional myocutaneous flap in more complicated RVF are of the common flaps. In proximal or high RVF, surgical excision of the rectal wall in regimental resection is the other surgical radical approach.

• #5

  https://drmaherabbas.com/colorectal-conditions/rectovaginal-fistula/

  Surgical intervention is the main treatment modality for women with rectovaginal fistula. Temporary medical measures to help control the symptoms of the fistula include antibiotics, high fiber diet, the judicious use of anti-diarrheal pills if diarrhea is present, the insertion of a vaginal tampon or pad, daily vaginal irrigation, and the use of skin protecting ointments. […] The following are some of the various types of surgery performed in patients with rectovaginal fistula: […] Abscess drainage. If a patient presents with acute abscess, incision and drainage of the abscess is the first step […] Abdominal surgery. Women with a high fistula deep in the vagina and those with a colovaginal or enterovaginal fistula (communication from the colon or small bowel to the vagina) require an abdominal operation to remove the involved segment of small or large bowel. Laparoscopic camera surgery (keyhole surgery) is Dr. Maher Abbas preferred method for patients with this type of fistulas. The advantages of keyhole surgery include less risk, less pain, and faster recovery

• #6 Rectovaginal fistula – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/symptoms-causes/syc-20377108

  A rectovaginal fistula may result from: […] Some rectovaginal fistulas may close on their own, but most need surgery to fix them. […] A rectovaginal fistula may form as a result of: […] In rare cases, prior surgery in your lower pelvic area, such as removing an infected Bartholin’s gland, can cause a fistula to develop. […] Among people with Crohn’s disease who develop a fistula, the chances of complications are high. These can include poor healing, or another fistula forming later. […] There are no steps you need to take to prevent a rectovaginal fistula.

• #7 Rectovaginal Fistula Treatment | UVA Health

  https://uvahealth.com/services/gastro/rectovaginal-fistula

  Some rectovaginal fistulas close up without treatment. But most will need surgery to close the connection. […] Surgery is usually needed to repair the fistula. The surgery closes the opening between your rectum and vagina. We may use tissue from another body part to use as a graft. This tissue will help to close the fistula. […] You may need antibiotics if there is an infection in the area around your fistula.

• #8 Rectovaginal Fistula | Colon & Rectal Surgical Specialists

  https://www.crssny.com/conditions/rectovaginal-fistula/

  If the fistula is infected, you may be prescribed antibiotics. For those who struggle with Crohns disease, medications such as Infliximab can ease inflammation and allow the fistula to begin healing. […] In many cases, surgery is needed to repair a fistula. However, because fistulas can sometimes close on their own, our doctors may recommend waiting three to six months before you commit. […] If surgery is determined to be the best option for treatment, the procedure may combine a number of techniques, including: Suturing an anal fistula plug to allow natural tissue to grow over the fistula, Applying a tissue graft over the fistula, Repairing damaged sphincter muscles in the anus. […] However, its important to keep in mind that home remedies are not an alternative to medication or surgery. These lifestyle changes are usually recommended to keep you comfortable and reduce your risk of infection while waiting for repair.

• #9 Rectovaginal Fistula Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193277-treatment

  Because the symptoms of rectovaginal fistula (RVF) are so distressing, surgical therapy is almost always indicated. Exceptions include patients who are moribund and those for whom the proposed anesthesia and surgery pose prohibitive risks. Note that surgical therapy means repair in most cases; however, some patients are better served by a diverting stoma than by an ill-advised repair attempt. Although repair commonly yields good rates of closure and patient satisfaction, even permanent fistula closure is not necessarily free of postoperative problems. […] Guidelines for management of RVF have been developed by the American Society of Colon and Rectal Surgeons (ASCRS; see Guidelines). […] Use local care, drainage of abscesses, and directed antibiotic therapy to treat acute RVFs of traumatic origin (including those caused by obstetric and operative trauma), RVFs complicated by secondary infection, and fistulas of infectious origin. Allow tissues to heal for 6-12 weeks. Dietary modification and supplemental fiber can greatly diminish symptoms during this period.

• #10 Rectovaginal Fistula Guidelines: ASCRS Guidelines for Rectovaginal Fistula

  https://emedicine.medscape.com/article/193277-guidelines

  In August 2022, the American Society of Colon and Rectal Surgeons (ASCRS) published guidelines on the management of rectovaginal fistula (RVF), which included the following recommendations: […] Nonoperative management is typically recommended for the initial care of obstetrical rectovaginal fistula and may also be considered for other benign and minimally symptomatic fistulas. […] A draining seton may facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas. […] Endorectal advancement flap with or without sphincteroplasty is the procedure of choice for most patients with a rectovaginal fistula. […] Episioproctotomy may be used to repair obstetrical or cryptoglandular rectovaginal fistulas in patients with anal sphincter defects. […] A gracilis muscle or bulbocavernosus (Martius) flap is typically recommended for recurrent or otherwise complex rectovaginal fistula.

• #11 Genitourinary and Rectovaginal Fistulas – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/obgyn/urogynecology/genitourinary-rectovaginal-fistulas

  Effective fistula treatment requires advanced care with an experienced team of specialized urogynecologic surgeons. At the University of Chicago Medicine, our experts will design a personalized plan to repair your fistula and improve your quality of life. […] Fistulas do not usually heal on their own. In most cases, surgery is needed to correct the problem and should only be performed by a urogynecologic surgeon with specialized training in fistula repair. […] Fistula repair surgery involves removing the fistula tract and repairing affected organs so they are no longer connected. It can be successfully performed using minimally invasive techniques (laparoscopic, robotic and through the vagina) to enhance healing and recovery. Whenever possible, treatment of the underlying cause of the fistula should occur before surgery to maximize its success.

• #12 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  Surgical options include: Removing the fistula. The fistula tunnel is removed, and the anal and vaginal tissues are repaired. […] Using a tissue graft. The surgeon removes the fistula and creates a flap out of nearby healthy tissue. The flap is used to cover the repair. Several different procedures using tissue or muscle flaps from the vagina or the rectum are an option. […] Repairing the anal sphincter muscles. If these muscles have been damaged by the fistula, during vaginal delivery, or by scarring or tissue damage from radiation or Crohn’s disease, they are repaired. […] Doing a colostomy before repairing a fistula in complex or recurrent cases. A procedure to divert stool through an opening in your belly instead of through your rectum is called a colostomy. A colostomy may be needed for a short time or, in very rare cases, it may be permanent. Most of the time, this surgery isn’t needed. […] If a colostomy is needed, your surgeon may wait 3 to 6 months. Then if your provider is sure that your fistula has healed, the colostomy can be reversed so that stool again passes through the rectum.

• #13 Treatment of Rectovaginal Fistula

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10129357/

  Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs. […] After determining the factors for treatment, the initial management of RVFs is non-operative, conservative treatment. […] Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relief the patient’s pain. […] The success rate of complex RVFs is poorer than that of simple RVFs even in previous cases with fail attempted repair. […] Numerous surgical techniques have been described for RVFs through various approaches: transanal, transperineal, transvaginal, and abdominal approach.

• #14 Rectovaginal Fistula (RVF) | Loma Linda University Health

  https://lluh.org/conditions/rectovaginal-fistula-rvf

  Surgery is necessary to correct a rectovaginal fistula. If the area around the fistula is infected, a patient may be given a course of antibiotics before surgery. […] The type of operation performed depends on the size and location of the fistula. Possible options for surgery include: […] Simple fistulotomy (opening up of the fistula tract) […] Advancement flap (creation of a flap of muscle and lining of the rectum) to cover the fistula. […] Combination of fistulotomy with an anal sphincter repair, referred to as sphincteroplasty. […] In very complicated fistulas, your surgeon may recommend a diverting colostomy prior to embarking on a challenging repair. Your surgeon should discuss whether this is a likely option.

• #15 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  Irrespective of the approach, the fistula tract should be removed to allow normal tissue with a good blood supply to knit together. If the tissue near the fistula tract has poor blood supply, a graft or flap may be placed to promote healing. Grafts, or flaps, can come from a womens own fat tissue or muscle that is placed over the repaired fistula tract. Other biologic grafts taken from animal tissue or human cadavers can also be used. The repair may also involve reconstruction of the internal and external anal sphincter muscles. […] Following rectovaginal fistula surgery, women should monitor their bowel habits with the goal of having daily bowel movements of soft, formed stool. Avoiding constipation and diarrhea is important as this can disrupt the repair and increase the risk of wound infection.

• #16 Rectovaginal Fistula Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193277-treatment

  Many fistulas resulting from obstetric or operative trauma heal completely, requiring no further therapy. When the fistula persists after this period of treatment and the tissues become uninflamed and supple, repair may be considered. […] Surgical treatment is almost always indicated. Typically, such treatment consists of repair via either a local or a transabdominal approach. […] Minimally invasive approaches have been described. […] The best results have been reported with transanal advancement flap repair. […] The vaginal mucosa is circumferentially elevated, exposing the fistula. […] Transabdominal approaches are generally used for high RVFs when the fistula originates from a neoplasm, from radiation, or, occasionally, from IBD. […] This is the simplest abdominal approach. The rectovaginal septum is dissected, the fistula is divided, and the rectum and vagina are closed primarily without bowel resection.

• #17 GMS | GMS German Medical Science — an Interdisciplinary Journal | German S3-Guideline: Rectovaginal fistula

  https://www.egms.de/en/journals/gms/2012-10/000166.shtml

  The surgical treatment of rectovaginal fistulas largely corresponds to the treatment of high transsphincteric anal fistulas. The most common procedure is fistula excision with sphincter suture and closure of the ostium in the rectum by an advancement flap. […] No randomized trials or relevant reviews or guidelines are available on the surgical treatment of rectovaginal fistulas. […] The endorectal closure technique essentially corresponds to the flap technique in high anal fistulas. […] The Martius procedure uses a pedicled flap of adipose tissue from the labia majora. The interposition of well-vascularized tissue is intended to separate and protect the vaginal from the rectal sutures. […] Augmentation of the rectovaginal septum can also be achieved by unilateral or bilateral interposition of the gracilis muscle.

• #18 Rectovaginal Fistula – Doç. Dr. Nuri Okkabaz

  https://www.nuriokkabaz.com/en/colorectal-diseases/rectovaginal-fistula/

  In addition to these local treatments, many surgical methods have been described. Depending on the approach area during surgery, these methods can be categorized into four different approaches: transperineal (entered between the vagina and anus), transvaginal (from the vagina side), transanal (from the anus side), and abdominal (entered through the abdomen). While the goal in all approaches is to eliminate the fistula, the techniques vary. […] The Martius flap technique has been described as a method used to repair fistulas between the urinary tract and vagina, where a flap of bulbocavernous muscle is used as a filler. […] In the method where the gracilis muscle is used as a flap, similar to the Martius flap, after preparing the tissues, the gracilis muscle is used as the flap. […] The endorectal advancement flap is a method applied through the anal route.

• #19 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  What are the treatment options? […] Not all fistulas need surgical intervention. Rectovaginal fistulas associated with inflammatory bowel disease may close on their own without surgery but should be managed with GI medicine or colorectal surgery. If diagnosed early after an inciting event, immediate closure may be considered. Most often, rectovaginal fistula repairs are delayed until inflammation around the fistula subsides. The surgical approach to rectovaginal fistulas may involve a repair either through the vagina (trans-vaginal) or through the anus/rectum (trans-anal/trans-rectal) repair. This depends on the surgeons training and the position and size of the fistula. If the fistula is large, a surgeon may consider a diverting colostomy to allow the tissue to heal. Closure of the colostomy is done once the fistula is healed. A stoma (ileostomy or colostomy) is where part of the bowel is brought to the surface of the skin of the abdomen so that the waste material (stool) empties into an airtight bag rather than passing through the rectum; it diverts the flow of feces away from the site of the repair.

• #20 Rectovaginal Fistula Repair with a Vascularized Gracilis Muscle Interposition Flap – CSurgeries

  https://csurgeries.com/video/rectovaginal-fistula-repair-with-a-vascularized-gracilis-muscle-interposition-flap/

  The surgical management of rectovaginal fistulas remains difficult, as they tend to be recurrent and vary widely in location and complexity. […] A transvaginal approach with an interposed vascularized gracilis muscle flap was indicated for repair due to the irradiated field and low-lying location of the rectovaginal fistula. […] Advantages: Transvaginal approach is suitable for low and middle-lying fistulas. Interposing a well vascularized muscle flap from outside the radiation field over the repaired rectovaginal fistula offers an increased chance of healing with a decreased recurrence rate. […] Disadvantages: This technique cannot be used for high-lying fistulas. […] Complication rate after gracilis muscle transposition is generally minimally, however there is a risk of injury to the saphenous nerve which runs superficial to the tendons at the pes anserinus. If the saphenous nerve is injured the patient can experience medial leg paresthesia and dysesthesia. There is also a risk of rectovaginal fistula recurrence.

• #21 Rectovaginal fistula – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/rectovaginal-fistula/

  Most of the time, this surgery isn’t needed. But you may need this if you’ve had tissue damage or scarring from previous surgery or radiation treatment, an ongoing infection or significant fecal contamination, a cancerous tumor, or an abscess. If a colostomy is needed, your surgeon may wait eight to 12 weeks before repairing the fistula. Usually after about three to six months and confirmation that your fistula has healed, the colostomy can be reversed and normal bowel function restored.

• #22 Rectovaginal Fistula Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193277-treatment

  When tissues are abnormal because of irradiation, inflammation, or neoplasm, the repair is doomed to failure unless the abnormal tissues are resected. […] A host of supplementary procedures have been described to augment bowel resection in the difficult pelvis. […] The onlay Bricker patch also has been used to repair RVFs, chiefly those produced by radiation. […] RVFs associated with Crohn disease are difficult to manage. […] Patients with relatively normal rectal mucosa and an RVF are good candidates for an endorectal advancement flap. […] Attention must be paid to the patient’s bowel habits. […] Postoperative care after transabdominal repair is identical to the care administered to all patients who have undergone major laparotomy with bowel resection and anastomosis. […] Complications of transabdominal repair may include the usual complications of any laparotomy with bowel resection, including fistula recurrence. […] Patients are seen 2 weeks after discharge for evaluation of wounds and bowel habits.

• #23 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

  https://www.iuga.org/spotlight-v18-1/management-of-complex-rectovaginal-fistula-urogynecological-perspective

  Obstetric fistulas account for most of the pelvic floor fistulas world-wide. Rectovaginal fistula (RVF) is an abnormal communication between the rectum and vagina. Injuries during childbirth are the most common cause of rectovaginal fistulas. Other causes include pelvic surgeries (including gynecological and rectal surgeries), inflammatory bowel disease, malignancy, and radiation (Kniery et al 2015). […] Recurrent fistulas may be considered complex as they are often associated with more scarring and hence a wider dissection may be required to obtain healthier vascular tissue for fistula closure. […] In inflammatory bowel disease related fistulas, the advice is not to perform the fistula repair while there is active inflammation but to first optimize medical management. […] Fecal diversion has not been shown to improve success rates for RVF repair (Browning Whiteside 2015; Thayalan et al 2022; Noori 2021).

• #24 Current treatment of rectovaginal fistula in Crohn’s disease

  https://www.wjgnet.com/1007-9327/full/v17/i8/963.htm

  The management involves an organized and detailed workup to accurately make the diagnosis and then implement the appropriate treatment. Only a combination of advanced imaging, physical examination, and clinical experience will afford the surgeon the opportunity to precisely identify the location and cause of this problem. There are no evidence-based randomized controlled trials for the appropriate management of RVFs. More focused studies targeting these patients with the use of combined medical and surgical therapy are necessary. […] Treatment of RVF is mainly surgical. However, medical therapy does have a role in the treatment of Crohns RVF. Over the years, attempts at healing Crohns RVF by medical treatment have been met with failure. The principles of medical therapy have been aimed at the treatment of the underlying active disease and include the use of antibiotics, corticosteroids, immunosuppressives and infliximab.

• #25 Radiation-induced rectovaginal fistula surgical treatment: a case report – Barzola – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/9975/html

  Radiation-induced rectovaginal fistula (RI-RVF) is a serious complication of radiation therapy for pelvic malignancies. We present here a new surgical approach which aims at decreasing recurrence rates by avoiding radiated tissue in the reconstruction. […] A combined repair via a Tuttle transvaginal access with a Turnbull-Cutait colon pull-through and Singapore flap can be an effective approach in cases where tissue healing is compromised due to prior radiation therapy. […] The best outcomes are seen when non-irradiated tissue is involved in the reconstruction, which can be achieved with a pull-through operation and delayed coloanal anastomosis. […] Tuttle transvaginal access, Turnbull-Cutait pull-through, and Singapore flap procedures could represent a viable reconstruction option for RI-RVFs, especially in a setting where local tissue quality is insufficient for re-anastomosis and wound healing.

• #26 Post-radiotherapy recto-vaginal fistula in cervical cancer – International Journal of Case Reports and Images (IJCRI)

  https://www.ijcasereportsandimages.com/archive/article-full-text/101349Z01WT2022

  Recto-vaginal fistula is defined as a pathological, epithelialized communication between the posterior wall of the vagina and the anterior wall of the rectum, through the recto-vaginal septum. […] As for management, it requires treatment of the underlying pathology, treatment of the fistula, and associated complications. There are two main treatment modalities: […] Conservative treatment: which consists of the use of fibrin glue to close the fistula, treatment of associated infections, and ensuring a good nutritional status; […] Surgical treatment consists of repairing the fistula by laparotomy or laparoscopy for high fistulas or by perineal or transvaginal approaches for low fistulas, associated with a drainage colostomy. […] In post-radiotherapy recto-vaginal fistulas, medical treatment is not very effective because of the lesions induced by irradiation, in particular the alteration of blood perfusion. Therefore, surgery remains the treatment of choice.

• #27 Therapeutic options in radiation-induced rectovaginal fistula – Current Gynecologic Oncology

  http://ginekologia.pl/index.php/issues/2016-vol-14-no-2/therapeutic-options-in-radiation-induced-rectovaginal-fistula

  Therapeutic options in radiation-induced rectovaginal fistula […] A pathological communication between the rectum and the vagina, referred to as rectovaginal fistula, can develop as a result of a number of factors. Fistula caused by ionizing energy treatment, which belongs to the most serious late radiation-induced complications, is a special type of this abnormality. This type of fistulas are classified as complex fistulas. Their surgical treatment is very difficult and shows poor efficacy as well as high rate of recurrence. Therefore, it is still a serious and current problem of women after radiation therapy for gynecologic cancer. […] Therefore, it is important to determine the optimal management strategy in these patients. Although it may seem impossible to develop a simple diagnostic and therapeutic algorithm due to different fistula locations and sizes, the knowledge on the basic management strategies increases the chance of success. A surgery using the transabdominal approach described by Parks is the primary surgical technique. However, new reports on repair techniques, particularly less invasive ones, occasionally occur in literature. Therefore, we present a current literature review of treatment options in radiation-induced rectovaginal fistulas.

• #28 Treatment of Rectovaginal Fistula, Rectal Ulcers or Anal Fissure with Stem Cell Injections | Swiss Medica

  https://www.startstemcells.com/rectovaginal-fistula-treatment.html

  Rectovaginal fistula (also known as colovaginal, or anovaginal fistula) is an abnormal aperture between a woman’s rectum and vagina. Due to such an opening, the contents of the rectum – gases or stool – can penetrate the vagina and cause hygiene problems, pain, vaginal or urinary tract infections, or other complications. […] Currently, traditional surgical and therapeutic methods to treat rectovaginal fistula do not offer a permanent solution; moreover, they still often have many side effects. […] Swiss Medica specialists have developed an innovative method of treating rectovaginal fistula based on stromal-vascular fraction (SVF) injections. SVF therapy has resulted in complete fistula healing according to a two-year clinical observation of patients. […] Compared to standard surgical treatment, the procedure is much less painful, does not require suturing, and the rehabilitation period is well-tolerated.

• #29 Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue

  https://www.mdpi.com/2227-9059/11/9/2509

  Novel Approach in Rectovaginal Fistula Treatment: Combination of Modified Martius Flap and Autologous Micro-Fragmented Adipose Tissue […] In this paper, we introduce an innovative therapeutic approach for managing rectovaginal fistulas (RVF), by combining the modified Martius flap and micro-fragmented adipose tissue (MFAT) enriched with mesenchymal stem cells (MSC). […] The integration of the modified Martius flap with MFAT emerges as a highly promising approach for addressing CD-related RVFs that had historically been, and still are, difficult to treat, given their often refractory nature and low healing success rates. […] The conservative therapeutic options for treating CD-related RVF include antibiotics and various immunomodulators such as tacrolimus, azathioprine, 6-mercaptopurine, and biologic agents.

• #30 Treatment of Radiation-Induced Rectovaginal Fistula: Safety and Efficacy of Fat Grafting and Stromal Vascular Fraction Injections | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-77455-4_27

  Radiation-induced rectovaginal fistula is a big challenge for both patient and surgeon. There is no reliable treatment option for this condition so far. […] Recent studies demonstrated that radiation damage can be reversed by means of fat grafting or adipose-derived regenerative cells injection. […] Our clinical trial demonstrated that combination of fat grafting and stromal vascular fraction injections is a safe and highly effective method for treatment of radiation-induced rectovaginal fistula.

• #31 Successful treatment of rectovaginal fistula and rectal stenosis due to perianal Crohn’s disease by dual-port laparoscopic abdominoperineal resection: a report of two cases | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-016-0211-0

  The incidence of rectovaginal fistula in women with Crohns disease has been reported to be 310 %. Although rectovaginal fistulas can be managed medically and surgically, they have high rates of recurrence and complications. […] This report describes the use of the same method for two patients with Crohns disease-related rectovaginal fistula and rectal stenosis. […] These findings show that this reduced port method can be used to successfully treat patients with Crohns disease-associated rectovaginal fistula and rectal stenosis. […] The novel, minimally invasive procedure described here, dual-port laparoscopic abdominoperineal resection using a multiple port, has been found effective in patients with lower rectal cancer and in patients with medically uncontrolled ulcerative colitis. […] This report describes our use of this surgical method in two patients with CD-related RVF and rectal stenosis. […] Dual-port laparoscopic abdominoperineal resection using a multichannel port, when performed by experienced surgeons, may be useful for selected patients with these conditions.

• #32

  https://link.springer.com/article/10.1007/s00192-016-3097-2

  Rectovaginal fistula (RVF) is an abnormal epithelium-lined connection between the rectum and vagina. The primary effective treatment is surgical repair, but recurrence remains a challenge. Magnetic compression anastomosis (MCA), an alternative to suturing, has been developed to generate an anastomosis between various hollow viscera. We hypothesized that the MCA approach could be used to treat RVF. […] The compression procedure applied to our patient with RVF was successful. The patient recovered quickly without complications, and RVF did not recur during a 15-month follow-up. […] From this preliminary investigation, MCA using our novel device appears to be a safe, simple, and effective nonsurgical procedure for the treatment of RVF.

• #33 Fistulas – Urogynecology & Pelvic Health | UCLA Health

  https://www.uclahealth.org/medical-services/womens-pelvic-health/conditions-treated/fistulas

  Fistulas are preventable and treatable. […] Proper medical care makes fistulas both treatable and preventable. […] Fistulas generally do not heal on their own. Some small vesicovaginal fistulas that are detected early may be treated by placing a catheter in the bladder for a period of time. However, the treatment for most fistulas is surgical repair. […] Most often vesicovaginal fistula can be repair by a minimally invasive vaginal approach. In some cases a minimally invasive laparoscopic or robotic or open surgical approach maybe preferred. […] If you have been diagnosed with fistulas or are experiencing symptoms associated with fistulas, contact us to request an appointment with one of our urogynecologists to learn more about your treatment options.

• #34 Effective Laser Treatment for Rectovaginal Fistula: Mumbai Piles Laser Clinic

  https://www.mumbaipilesclinic.com/post/effective-laser-treatment-for-rectovaginal-fistula-mumbai-piles-laser-clinic

  Rectovaginal fistula is a medical condition in which an abnormal connection is formed between the rectum and the vagina, allowing stool or gas to pass through the vagina. This can cause significant discomfort and embarrassment for individuals affected by the condition. […] Various treatment options are available for rectovaginal fistula, including surgical repair, fistulotomy, and seton placement. However, these treatments may not always be effective or may have associated risks and complications. […] Laser treatment has emerged as a potential alternative or complementary treatment option for rectovaginal fistula. In this procedure, a laser is used to create an opening through the rectal wall, allowing the fistula to be accessed and treated. Laser treatment can be performed using different types of lasers, including carbon dioxide (CO2) lasers.

• #35 Effective Laser Treatment for Rectovaginal Fistula: Mumbai Piles Laser Clinic

  https://www.mumbaipilesclinic.com/post/effective-laser-treatment-for-rectovaginal-fistula-mumbai-piles-laser-clinic

  The use of laser treatment for rectovaginal fistula is still relatively new, and the available research on its effectiveness is limited. However, some studies have reported promising results. For example, a study published in the Journal of Obstetrics and Gynaecology Research found that CO2 laser treatment resulted in complete closure of the fistula in 60% of patients, with partial closure in an additional 28%. […] Another study published in the Journal of Minimally Invasive Gynecology reported that 85% of patients who underwent laser treatment for rectovaginal fistula experienced complete closure of the fistula, with no adverse effects reported. […] The laser treatment procedure typically involves the use of a specialized laser probe that is inserted through the anus and into the rectum. The laser is then used to create an opening in the rectal wall, allowing the fistula to be accessed and treated. The laser energy is directed at the fistula tract, causing it to shrink and seal off. The procedure is usually performed under local anesthesia or sedation, and patients may experience some discomfort or cramping during the procedure.

• #36 Rectovaginal Fistula | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/urogynecology/bowel-issues/rectovaginal-fistula/

  What are rectovaginal fistula treatments? Small rectovaginal fistulas may heal on their own over time. You may need antibiotics for infections or medications for IBD. […] Most people with rectovaginal fistulas need surgery to close the opening. Dr Guerette may use your tissue or a collagen graft to repair a rectovaginal fistula. Success rates are over 90%. […] What happens after rectovaginal fistula repair? These steps can aid your recovery after rectovaginal fistula repair surgery: Take antibiotics as prescribed to lower infection risk. Don’t have sex, use tampons or douche until we give the OK. Prevent constipation and diarrhea (which can cause infection) by eating a healthy, high-fiber diet and drinking plenty of water. Use laxatives or stool softeners as directed by the IWI team.

• #37 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The success rate for rectovaginal fistula repair is high, ranging from 90-95%. Patients with recurrent fistulas or a history of radiation may have a poorer outcome. Fecal incontinence, even with successful fistula repair, up to 30-40% of women may still experience fecal incontinence with leakage of stool or gas from the anus, especially if the fistula involved the anal muscles. […] Some women are never cured of their fistula, meaning it never fully closes. However, surgery often shrinks the fistula to such a small size that an acceptable outcome is reached, and further surgery is declined. Sometimes a surgical thread, called a se-ton, is placed through the fistula to help control drainage and again, symptoms are controlled such that no further surgery is required.

• #38 Treatment of Rectovaginal Fistula

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10129357/

  Simple fistula is usually indicated for local repair. Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. Interposition of healthy, well-vascularized tissue can be required for more complex fistulas such as those secondary to radiation. […] The period 9 months between diagnosis and first surgery is reported to be one of independent factors for success. […] About half of patients with RVFs need multiple surgery. […] The success rate of fistula excision with multi-layered closure of the rectum and the vagina accompanying omental interposition is 90%-100% for RVFs with various causes.

• #39 Vaginal fistula: Types, symptoms, and causes

  https://www.medicalnewstoday.com/articles/vaginal-fistula

  A rectovaginal fistula describes a connection between the vagina and the rectum. This opening may result in the passage of stool and gas through the tract. Trauma during vaginal birth is the most common cause of this kind of fistula. This type can also occur due to other medical conditions, such as Crohns disease. […] A person’s treatment will depend on the type and location of their fistula. Some small vaginal fistulas may heal on their own, while larger ones will require surgery. A doctor may suggest different surgical approaches depending on the fistula’s severity, complexity, and recurrence. Often, a surgeon will perform this through a minimally invasive laparoscopic procedure or open surgery. […] Like all major surgeries, surgical repair of vaginal fistulas comes with risks. These may include: infections, injury, bleeding, thromboembolism.

• #40 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

  https://www.mdpi.com/2077-0383/12/19/6421

  The probable mechanism of action of metronidazole in the prevention of RVF should be seen in the reduction in anaerobic necrosis, which in the case of cervical cancer may be a risk factor for RVF. […] The protective effect of creating a diversion stoma on the prognosis of RVF is still unproven; however, according to recommendations, it is still the first step to relieve symptoms and inflammation after the onset of RVF. […] In conclusion, the creation of a drainage stoma, especially in the early stages of RVF treatment, can prevent leakage from spreading and increase the likelihood of fistula healing. […] In order to achieve positive results of RVF treatment, an individualized approach to the patient seems necessary, which will take into account the etiology of the fistula, age and comorbidities. Efforts should be made to stabilize the patient’s condition with comorbidities that may negatively affect blood flow and immune mechanisms, which will interfere with the fistula repair process.

• #41 Treatment of Rectovaginal Fistula

  https://www.jstage.jst.go.jp/article/jarc/7/2/7_2023-007/_article/-char/ja/

  Rectovaginal fistula (RVF) is a challenging complication with unsatisfactory success and a significant burden for the patients. […] The present state of treatments for RVFs was reviewed especially from the point of factors to determine management, classifications, principle of treatment, conservative and surgical treatments with outcomes. […] Starting with conservative surgical options and interposing healthy tissue for complex or recurrent fistulas, invasive procedures will be performed if conservative treatment failed. […] Conservative treatment may be effective in RVFs with minimal symptoms and should be done for small RVFs for a 36 months usual period. […] Diverting stoma can initially be constructed in patients with severe symptoms and larger RVFs to relieve the patient’s pain. […] Simple fistula is usually indicated for local repair. […] Local repairs to transperineal and transabdominal approaches can be used for complex RVFs. […] Interposition of healthy, well-vascularized tissue can be required for more complex fistulas and abdominal procedures for high RVFs.

• #42 Genitourinary and Rectovaginal Fistulas – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/obgyn/urogynecology/genitourinary-rectovaginal-fistulas

  At UChicago Medicine, our fellowship-trained urogynecologic surgeons are experts in fistula repair. The Center for Pelvic Health also brings together experts from multiple specialties, including urogynecology, colorectal surgery, urology and radiology to provide coordinated care for our patients who have more complicated cases requiring a multidisciplinary approach.

• #43 Recto-Vaginal and Vesico-Vaginal Fistula Treatment

  https://www.rwjbh.org/rwj-university-hospital-new-brunswick/treatment-care/pelvic-floor-and-incontinence-program/urogenital-fistula-treatment/

  Fistulas are complex conditions and must be treated by expert physicians who are trained in advanced pelvic floor surgery. […] Our team of urogynecologists often collaborates with colorectal surgeons and uses a variety of surgical techniques to repair fistulas.

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