Materiały źródłowe

• #1 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

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

  A fistula is an abnormal connection between 2 epithelial surfaces. […] Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] The recto-vaginal fistula starts from the rectum and extends to the vagina. It is not a healthy situation or physiological status. There is usually an underlying pathology, injury, or surgical event. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #2 Rectovaginal Fistula | Intimate Wellness Institute

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

  A rectovaginal fistula is a tunnel-like opening that develops between your vagina and rectum. […] In a rectovaginal fistula, damage to vaginal tissue causes the tissue to tear or die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. […] Trauma to vaginal tissue or pressure to the tissue that stops blood flow, causing the tissue to die and creating a fistula are by far the most common causes. Rectovaginal fistulas can develop in a matter of days or they may form over several years. […] Causes of rectovaginal fistulas include: Prolonged labor, vaginal tears during childbirth or if your healthcare provider made a cut (incision) to help you deliver your baby (episiotomy). […] 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%. […] Rarely, a fistula doesn’t heal properly, or it opens up again after treatment. This is most likely to happen if you have colon cancer or Crohns disease or other risk factors like poorly controlled diabetes or if you smoke.

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

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

  A rectovaginal fistula (RVF) is an abnormal connection between the rectum and vagina that can result in the passage of gas and/or stool through a tract. […] The most common causes of rectovaginal fistula are: Trauma or tearing of the perineum (the area between the anus and the vulva) during childbirth, Crohns disease or inflammatory bowel disease, Prior pelvic surgery, An infection, Cancer. […] 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. […] It is common for an injury to the anal sphincters to occur at the time of the obstetrical trauma. 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.

• #4 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

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

  A fistula is an abnormal connection between 2 epithelial surfaces. […] Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] The recto-vaginal fistula starts from the rectum and extends to the vagina. It is not a healthy situation or physiological status. There is usually an underlying pathology, injury, or surgical event. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #5 Rectovaginal Fistula – StatPearls – NCBI Bookshelf

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

  A fistula is an abnormal connection between 2 epithelial surfaces. […] Recto-vaginal fistula starts from the rectum and extends to the vagina. This activity describes the pathophysiology, etiology, and presentation of rectovaginal fistula and highlights the role of the interprofessional team in its management. […] The recto-vaginal fistula starts from the rectum and extends to the vagina. It is not a healthy situation or physiological status. There is usually an underlying pathology, injury, or surgical event. […] Like other fistulae, RVF is a result of a complication of an underlying disease, surgical procedure, or injury. A good understanding of the pathophysiological process helps to assess better, manage, and prevent fistulae. Loss of wall integrity with ongoing inflammatory, infectious, or neoplastic processes at the rectal or vaginal wall can lead to erosion to the adjacent tissue or organ and establish an abnormal fistulous connection. When the initial process is reversible or curable, such as diverticulitis, fistulae have a better chance to resolve.

• #6 Rectovaginal Fistula: Causes, Symptoms & Treatment

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

  In a rectovaginal fistula, damage to vaginal tissue causes the tissue to die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. […] Trauma to vaginal tissue stops blood flow, causing the tissue to die and creating a fistula. Rectovaginal fistulas can develop in a matter of days. Or they may form over several years. […] Causes of rectovaginal fistulas include: Prolonged labor, vaginal tears during childbirth or if your healthcare provider made a cut (incision) to help you deliver your baby (episiotomy). Abdominal or pelvic surgery, including C-section and hysterectomy. Cancer in your pelvic area, such as cervical cancer or colorectal (colon) cancer. Inflammatory bowel diseases (IBD) like Crohns disease and ulcerative colitis. Colon infections like diverticulitis. Radiation therapy to your pelvic region.

• #7 Rectovaginal Fistula | Intimate Wellness Institute

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

  A rectovaginal fistula is a tunnel-like opening that develops between your vagina and rectum. […] In a rectovaginal fistula, damage to vaginal tissue causes the tissue to tear or die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. […] Trauma to vaginal tissue or pressure to the tissue that stops blood flow, causing the tissue to die and creating a fistula are by far the most common causes. Rectovaginal fistulas can develop in a matter of days or they may form over several years. […] Causes of rectovaginal fistulas include: Prolonged labor, vaginal tears during childbirth or if your healthcare provider made a cut (incision) to help you deliver your baby (episiotomy). […] 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%. […] Rarely, a fistula doesn’t heal properly, or it opens up again after treatment. This is most likely to happen if you have colon cancer or Crohns disease or other risk factors like poorly controlled diabetes or if you smoke.

• #8 Rectovaginal Fistula: Causes, Symptoms & Treatment

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

  In a rectovaginal fistula, damage to vaginal tissue causes the tissue to die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. […] Trauma to vaginal tissue stops blood flow, causing the tissue to die and creating a fistula. Rectovaginal fistulas can develop in a matter of days. Or they may form over several years. […] Causes of rectovaginal fistulas include: Prolonged labor, vaginal tears during childbirth or if your healthcare provider made a cut (incision) to help you deliver your baby (episiotomy). Abdominal or pelvic surgery, including C-section and hysterectomy. Cancer in your pelvic area, such as cervical cancer or colorectal (colon) cancer. Inflammatory bowel diseases (IBD) like Crohns disease and ulcerative colitis. Colon infections like diverticulitis. Radiation therapy to your pelvic region.

• #9 Rectovaginal Fistula: Causes, Symptoms And Treatment

  https://www.netmeds.com/health-library/post/rectovaginal-fistula-causes-symptoms-and-treatment?srsltid=AfmBOorZ_padAvlCYH9piXsK7BDtfrqDnI07Ypf-wPx6wXZIXTJTQN8j

  In most cases, injury to the vaginal tissue stops the blood flow, resulting in the death of the particular tissue and creating a fistula. […] Although rectovaginal fistulas can develop in a matter of days, they can also gradually form over several years. […] Some of the most common causes of a rectovaginal fistula include: Prolonged labour pain spreading for days: During a long or complicated delivery, the perineum layer can rupture, or the doctor might have to cut the perineum (episiotomy) to deliver the baby. […] Inflammatory bowel disease (IBD): Different types of IBD like Crohns disease and ulcerative colitis often cause inflammation in the digestive tract. These inflammatory conditions can often increase the risk of developing a fistula. […] Radiation to the pelvic region: Exposure to radiation therapy for treating cancer in the vagina, uterus, cervix, rectum, or anus can often cause a rectovaginal fistula.

• #10 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

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

  The factors involved in the pathogenesis of CD are transforming growth factor β, TNF and IL-13 in the inflammatory infiltrate, which induce the epithelial–mesenchymal transition and the upregulation of matrix metalloproteinases, which may lead to the formation of a fistula. […] In a study by de La Poza et al., no influence of the location and clinical presentation of CD on the response to treatment of genital fistulae was observed. […] Therefore, the probable cause of poorer fistula repair results in women operated by abdominal access was not only a large number of comorbidities but also an older age. […] The use of MSCs may therefore be a promising strategy in the treatment of lesions caused by irradiation and regeneration of tissue damage. […] The healing effect of RVF appears to be influenced by estrogens affecting vaginal trophism.

• #11 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  The management of fistulas associated with Crohn’s disease is controversial and remains a challenge for clinicians. […] Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent. […] Tissue hypoxia and progressive endarteritis obliterans are the purported etiology of radiation injury. […] The etiology of the fistula must be appreciated when anticipating a transabdominal repair for a high fistula.

• #12 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

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

  The factors involved in the pathogenesis of CD are transforming growth factor β, TNF and IL-13 in the inflammatory infiltrate, which induce the epithelial–mesenchymal transition and the upregulation of matrix metalloproteinases, which may lead to the formation of a fistula. […] In a study by de La Poza et al., no influence of the location and clinical presentation of CD on the response to treatment of genital fistulae was observed. […] Therefore, the probable cause of poorer fistula repair results in women operated by abdominal access was not only a large number of comorbidities but also an older age. […] The use of MSCs may therefore be a promising strategy in the treatment of lesions caused by irradiation and regeneration of tissue damage. […] The healing effect of RVF appears to be influenced by estrogens affecting vaginal trophism.

• #13 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

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

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #14 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  Rectovaginal fistulas may be acquired or congenital. Acquired causes may be infective, inflammatory, neoplastic, or radiation-induced, or they may be posttraumatic; secondary to penetrating trauma, blunt perineal trauma, forceful coitus; and the result of postoperative and postobstetric injuries. […] Obstetric lacerations of the birth canal and perineum are common with vaginal birth. […] Factors that may lead to a fistula include failure to recognize and repair a laceration of the rectovaginal septum or subsequent infection, abscess, or hematoma formation. […] Fistulas may result from direct or unrecognized rectal injury, cautery injury, or anastomotic leak or infection at the time of a surgical procedure. […] Crohn’s disease is characterized by transmural bowel inflammation and a high tendency to form fistulas with adjacent structures.

• #15 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

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

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #16 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

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

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #17 Rectovaginal Fistula: Practice Essentials, Anatomy, Pathophysiology

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

  Several traumatic mechanisms for the development of RVF exist. Perineal lacerations during childbirth, especially those due to episioproctotomy, predispose patients to RVFs. […] Vaginal or rectal operative procedures, especially those performed near the dentate line, may cause RVFs. Stapled hemorrhoidopexy, STARR (stapled transanal rectal resection), and TRANSTAR (transanal stapler-assisted resection) have been increasingly associated with RVFs. […] Crohn disease and, less often, ulcerative colitis have been associated with RVFs. The fistula may arise primarily or, more often, in relation to a perirectal abscess or fistula, manifesting as complicated perianal sepsis. […] A variety of infectious conditions can produce RVF. The most common are perirectal abscess/fistula and diverticulitis. Less commonly, tuberculosis, lymphogranuloma venereum, and Bartholin gland abscess can cause RVFs.

• #18 Volume 1, Chapter 91. Rectovaginal Fistulas

  http://www.glowm.com/resources/glowm/cd/pages/v1/v1c091.html

  A rectovaginal fistula is an epithelialized communication between the rectum and the vagina (when distal to the dentate line, it is an anovaginal fistula). Rectovaginal fistulas may cause distressing symptoms, and their severity depends on the size and site of the fistulous tract. They are the scope of both the gynecologist and the colorectal surgeon. […] Rectovaginal fistulas may be acquired or congenital. Acquired causes may be infective, inflammatory, neoplastic, or radiation-induced, or they may be posttraumatic; secondary to penetrating trauma, blunt perineal trauma, forceful coitus; and the result of postoperative and postobstetric injuries. Congenital anorectal abnormalities occur in approximately 1 in 5000 births. In female infants with high anorectal agenesis, the rectum may open into the vagina via a fistula to the posterior fornix. This chapter focuses on the diagnosis and treatment of acquired defects.

• #19 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. […] RVFs account for approximately 5% of all perirectal fistulas, most commonly occurring as a result of obstetric trauma (85%) and pelvic surgery (5%-7%); while inflammatory bowel disease, malignancy, and radiation therapy encompass the majority of the remaining etiologies. […] Although obstetric trauma causes the vast majority of RVFs, they are still relatively uncommon in this population, occurring in only approximately 0.1% of vaginal deliveries in Western countries. […] Outside of delivery complications, hysterectomy and rectal surgery are the highest risk procedures for causing RVFs. […] Another potential source of the RVF is from the adjuvant radiation therapy that is commonly used to help treat these pelvic malignancies.

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

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

  Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. […] Rectovaginal fistula (RVF) is defined as an epithelium-lined abnormal communication between rectum and vagina. It is reported to represent approximately 5% of all anorectal fistulas. […] The majority of rectovaginal fistulas, 88%, are caused by obstetric trauma (postpartum rectovaginal fistula). The total number of cases corresponds to 0.1% of all vaginal births. […] Only a small percentage of rectovaginal fistulas is of cryptoglandular origin. Rectovaginal fistulas are frequently experienced in the postpartum period, some as a result of perineal tears. Another type is rectovaginal fistula in chronic inflammatory bowel disease (especially Crohn’s disease). Rectal surgery with low anastomosis, with or without pouch, can also lead to the formation of rectovaginal fistulas.

• #21 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] Rectovaginal fistulas may be caused by childbirth. Prolonged labor with necrosis of the rectovaginal septum or obstetric injury with a third- or fourth-degree perineal tear or episiotomy can lead to rectovaginal fistula. Inadequate repair, breakdown of the repair, or infection can all result in fistula development. […] Infectious processes within the rectovaginal septum can also result in a rectovaginal fistula. Cryptoglandular anorectal abscesses and Bartholin gland infections may spontaneously drain causing a low rectovaginal fistula. […] Malignancies may cause rectovaginal fistulas. These are usually seen in the setting of rectal, uterine, cervical, or vaginal malignancies that have significant local extension or have been treated with radiation therapy. Following radiation therapy, the patient may develop proctitis followed by ulceration of the anterior rectal wall. Rectal ulcers then progress to fistula formation around 6 months to 2 years posttherapy.

• #22 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] Rectovaginal fistulas may be caused by childbirth. Prolonged labor with necrosis of the rectovaginal septum or obstetric injury with a third- or fourth-degree perineal tear or episiotomy can lead to rectovaginal fistula. Inadequate repair, breakdown of the repair, or infection can all result in fistula development. […] Infectious processes within the rectovaginal septum can also result in a rectovaginal fistula. Cryptoglandular anorectal abscesses and Bartholin gland infections may spontaneously drain causing a low rectovaginal fistula. […] Malignancies may cause rectovaginal fistulas. These are usually seen in the setting of rectal, uterine, cervical, or vaginal malignancies that have significant local extension or have been treated with radiation therapy. Following radiation therapy, the patient may develop proctitis followed by ulceration of the anterior rectal wall. Rectal ulcers then progress to fistula formation around 6 months to 2 years posttherapy.

• #23 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. […] RVFs account for approximately 5% of all perirectal fistulas, most commonly occurring as a result of obstetric trauma (85%) and pelvic surgery (5%-7%); while inflammatory bowel disease, malignancy, and radiation therapy encompass the majority of the remaining etiologies. […] Although obstetric trauma causes the vast majority of RVFs, they are still relatively uncommon in this population, occurring in only approximately 0.1% of vaginal deliveries in Western countries. […] Outside of delivery complications, hysterectomy and rectal surgery are the highest risk procedures for causing RVFs. […] Another potential source of the RVF is from the adjuvant radiation therapy that is commonly used to help treat these pelvic malignancies.

• #24 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: […] A rectovaginal fistula may form as a result of: […] Delivery-related injuries are the most common cause of rectovaginal fistulas. […] The second most common cause of rectovaginal fistulas is Crohn’s disease and, more rarely, ulcerative colitis. […] A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. […] In rare cases, prior surgery in your lower pelvic area, such as removing an infected Bartholin’s gland, can cause a fistula to develop. […] Infection of small, bulging pouches in your digestive tract, called diverticulitis, may cause the rectum or large intestine to stick to the vagina and may lead to a fistula. […] Rarely, a rectovaginal fistula may develop following infections in the skin around the anus or vagina.

• #25 Rectovaginal fistula // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/rectovaginal-fistula

  A rectovaginal fistula may result from: […] A rectovaginal fistula may form as a result of: […] Delivery-related injuries are the most common cause of rectovaginal fistulas. […] The second most common cause of rectovaginal fistulas is Crohn’s disease and, more rarely, ulcerative colitis. […] A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. […] In rare cases, prior surgery in your lower pelvic area, such as removing an infected Bartholin’s gland, can cause a fistula to develop. […] Infection of small, bulging pouches in your digestive tract, called diverticulitis, may cause the rectum or large intestine to stick to the vagina and may lead to a fistula. […] Rarely, a rectovaginal fistula may develop following infections in the skin around the anus or vagina.

• #26 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  Rectovaginal fistulas may be acquired or congenital. Acquired causes may be infective, inflammatory, neoplastic, or radiation-induced, or they may be posttraumatic; secondary to penetrating trauma, blunt perineal trauma, forceful coitus; and the result of postoperative and postobstetric injuries. […] Obstetric lacerations of the birth canal and perineum are common with vaginal birth. […] Factors that may lead to a fistula include failure to recognize and repair a laceration of the rectovaginal septum or subsequent infection, abscess, or hematoma formation. […] Fistulas may result from direct or unrecognized rectal injury, cautery injury, or anastomotic leak or infection at the time of a surgical procedure. […] Crohn’s disease is characterized by transmural bowel inflammation and a high tendency to form fistulas with adjacent structures.

• #27 Volume 1, Chapter 91. Rectovaginal Fistulas

  http://www.glowm.com/resources/glowm/cd/pages/v1/v1c091.html

  Fistulas may result from direct or unrecognized rectal injury, cautery injury, or anastomotic leak or infection at the time of a surgical procedure. […] The management of fistulas associated with Crohns disease is controversial. For enterovaginal fistulas complicating Crohns, the ileal or colonic segments associated with a high fistula need to be resected. […] Rectovaginal fistulas are more commonly associated with Crohns disease than ulcerative colitis. Approximately 3% of patients with ulcerative colitis develop rectovaginal fistulas. […] It has been reported that up to 6% of women receiving pelvic irradiation will develop rectovaginal fistulas. Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent.

• #28 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  The management of fistulas associated with Crohn’s disease is controversial and remains a challenge for clinicians. […] Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent. […] Tissue hypoxia and progressive endarteritis obliterans are the purported etiology of radiation injury. […] The etiology of the fistula must be appreciated when anticipating a transabdominal repair for a high fistula.

• #29 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Operative trauma can result in rectovaginal fistula. Low fistulas may be the result of anorectal and vaginal operations. […] Inflammatory bowel disease is another possible culprit. Both ulcerative colitis and Crohn disease can be associated with rectovaginal fistula. Crohn disease is more frequently associated with rectovaginal fistula because it causes transmural inflammation of the rectal wall. […] Rectovaginal fistulas are considered complex if they are large (2.5 cm), high, or caused by inflammatory bowel disease. Recurrent fistulas are also considered complex due to their association with tissue scarring and decreased blood supply. […] Due to the abnormal surrounding tissue, high location, and large size of complex fistulas, attempts at local repair are fraught with failure. The unhealthy tissue must be removed and new, viable tissue introduced to correct the problem. This is usually accomplished with abdominal resection procedures or tissue interposition techniques. […] Management of rectovaginal fistulas in patients with Crohn disease has improved secondary to advances in medical therapy. Control of inflammation has allowed some patients to be treated with local repair techniques.

• #30 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  The management of fistulas associated with Crohn’s disease is controversial and remains a challenge for clinicians. […] Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent. […] Tissue hypoxia and progressive endarteritis obliterans are the purported etiology of radiation injury. […] The etiology of the fistula must be appreciated when anticipating a transabdominal repair for a high fistula.

• #31 Volume 1, Chapter 91. Rectovaginal Fistulas

  http://www.glowm.com/resources/glowm/cd/pages/v1/v1c091.html

  Fistulas may result from direct or unrecognized rectal injury, cautery injury, or anastomotic leak or infection at the time of a surgical procedure. […] The management of fistulas associated with Crohns disease is controversial. For enterovaginal fistulas complicating Crohns, the ileal or colonic segments associated with a high fistula need to be resected. […] Rectovaginal fistulas are more commonly associated with Crohns disease than ulcerative colitis. Approximately 3% of patients with ulcerative colitis develop rectovaginal fistulas. […] It has been reported that up to 6% of women receiving pelvic irradiation will develop rectovaginal fistulas. Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent.

• #32 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. […] RVFs account for approximately 5% of all perirectal fistulas, most commonly occurring as a result of obstetric trauma (85%) and pelvic surgery (5%-7%); while inflammatory bowel disease, malignancy, and radiation therapy encompass the majority of the remaining etiologies. […] Although obstetric trauma causes the vast majority of RVFs, they are still relatively uncommon in this population, occurring in only approximately 0.1% of vaginal deliveries in Western countries. […] Outside of delivery complications, hysterectomy and rectal surgery are the highest risk procedures for causing RVFs. […] Another potential source of the RVF is from the adjuvant radiation therapy that is commonly used to help treat these pelvic malignancies.

• #33 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] These fistulas can also occur following a failed repair of a third- or fourth-degree laceration of the perineum, from unrecognized injury at the time of vaginal delivery, and from episiotomy infection. Radiation damage and Crohn disease are two other important causes of RVFs. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #34 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas/print

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #35 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] Rectovaginal fistulas may be caused by childbirth. Prolonged labor with necrosis of the rectovaginal septum or obstetric injury with a third- or fourth-degree perineal tear or episiotomy can lead to rectovaginal fistula. Inadequate repair, breakdown of the repair, or infection can all result in fistula development. […] Infectious processes within the rectovaginal septum can also result in a rectovaginal fistula. Cryptoglandular anorectal abscesses and Bartholin gland infections may spontaneously drain causing a low rectovaginal fistula. […] Malignancies may cause rectovaginal fistulas. These are usually seen in the setting of rectal, uterine, cervical, or vaginal malignancies that have significant local extension or have been treated with radiation therapy. Following radiation therapy, the patient may develop proctitis followed by ulceration of the anterior rectal wall. Rectal ulcers then progress to fistula formation around 6 months to 2 years posttherapy.

• #36 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] Rectovaginal fistulas may be caused by childbirth. Prolonged labor with necrosis of the rectovaginal septum or obstetric injury with a third- or fourth-degree perineal tear or episiotomy can lead to rectovaginal fistula. Inadequate repair, breakdown of the repair, or infection can all result in fistula development. […] Infectious processes within the rectovaginal septum can also result in a rectovaginal fistula. Cryptoglandular anorectal abscesses and Bartholin gland infections may spontaneously drain causing a low rectovaginal fistula. […] Malignancies may cause rectovaginal fistulas. These are usually seen in the setting of rectal, uterine, cervical, or vaginal malignancies that have significant local extension or have been treated with radiation therapy. Following radiation therapy, the patient may develop proctitis followed by ulceration of the anterior rectal wall. Rectal ulcers then progress to fistula formation around 6 months to 2 years posttherapy.

• #37 Rectovaginal Fistulas | GLOWM

  https://www.glowm.com/section-view/heading/Rectovaginal%20Fistulas/item/65

  The management of fistulas associated with Crohn’s disease is controversial and remains a challenge for clinicians. […] Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent. […] Tissue hypoxia and progressive endarteritis obliterans are the purported etiology of radiation injury. […] The etiology of the fistula must be appreciated when anticipating a transabdominal repair for a high fistula.

• #38 Volume 1, Chapter 91. Rectovaginal Fistulas

  http://www.glowm.com/resources/glowm/cd/pages/v1/v1c091.html

  Fistulas may result from direct or unrecognized rectal injury, cautery injury, or anastomotic leak or infection at the time of a surgical procedure. […] The management of fistulas associated with Crohns disease is controversial. For enterovaginal fistulas complicating Crohns, the ileal or colonic segments associated with a high fistula need to be resected. […] Rectovaginal fistulas are more commonly associated with Crohns disease than ulcerative colitis. Approximately 3% of patients with ulcerative colitis develop rectovaginal fistulas. […] It has been reported that up to 6% of women receiving pelvic irradiation will develop rectovaginal fistulas. Rectovaginal fistulas are most commonly associated with radiation therapy for endometrial, cervical, and vaginal cancers and are dose-dependent.

• #39 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Rectovaginal fistulas are abnormal epithelial-lined connections between the rectum and vagina. They can be quite bothersome to both the patient and the surgeon due to their irritating and embarrassing symptoms and high failure rate after repair. […] Rectovaginal fistulas may be caused by childbirth. Prolonged labor with necrosis of the rectovaginal septum or obstetric injury with a third- or fourth-degree perineal tear or episiotomy can lead to rectovaginal fistula. Inadequate repair, breakdown of the repair, or infection can all result in fistula development. […] Infectious processes within the rectovaginal septum can also result in a rectovaginal fistula. Cryptoglandular anorectal abscesses and Bartholin gland infections may spontaneously drain causing a low rectovaginal fistula. […] Malignancies may cause rectovaginal fistulas. These are usually seen in the setting of rectal, uterine, cervical, or vaginal malignancies that have significant local extension or have been treated with radiation therapy. Following radiation therapy, the patient may develop proctitis followed by ulceration of the anterior rectal wall. Rectal ulcers then progress to fistula formation around 6 months to 2 years posttherapy.

• #40 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] These fistulas can also occur following a failed repair of a third- or fourth-degree laceration of the perineum, from unrecognized injury at the time of vaginal delivery, and from episiotomy infection. Radiation damage and Crohn disease are two other important causes of RVFs. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #41 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas/print

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #42 Rectovaginal and anovaginal fistulas – UpToDate

  https://www.uptodate.com/contents/rectovaginal-and-anovaginal-fistulas

  Anovaginal fistulas (AVFs) and rectovaginal fistulas (RVFs) most frequently result from obstetric trauma, especially in resource-limited countries where prolonged obstructed labor can lead to pressure necrosis of the rectovaginal septum. […] These fistulas can also occur following a failed repair of a third- or fourth-degree laceration of the perineum, from unrecognized injury at the time of vaginal delivery, and from episiotomy infection. Radiation damage and Crohn disease are two other important causes of RVFs. […] RVFs may also occur following difficult hysterectomies, especially those performed for severe endometriosis with involvement or obliteration of the posterior cul-de-sac (pouch of Douglas); from extension or rupture of perirectal, perianal, and, rarely, Bartholin’s abscesses; and from any surgical procedures involving the posterior vaginal wall, perineum, anus, or rectum. […] In older women, RVFs can occur as a result of diverticulitis, colon cancer, or fecal impaction. In addition, treatment options for pelvic organ prolapse such as pessaries and various mesh repair procedures have been associated with RVFs.

• #43 Rectovaginal fistula and perineal breakdown | Obgyn Key

  https://obgynkey.com/rectovaginal-fistula-and-perineal-breakdown-2/

  Perineal body defects and rectovaginal fistulas (RVFs) are part of a spectrum of conditions that impact the posterior pelvic floor. […] Surgical management of these various defects requires a clear understanding of the anatomy of the distal portion of the posterior vaginal wall, the perineal body, the ASs, the rectum, and the anal canal. […] The surgical anatomy of the posterior pelvic floor remains an area of controversy among surgeons and anatomists. […] RVF is a congenital or acquired epithelialized tract between the rectum and the vagina. […] RVFs are classified according to their location and size; careful attention to both features allows determination of the approach for surgical repair. […] Another method of classification is based on the underlying cause of the fistula, which will be a better predictor of the ultimate success of the repair, as it takes into consideration the integrity of the local tissue and the health of the patient.

• #44 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Operative trauma can result in rectovaginal fistula. Low fistulas may be the result of anorectal and vaginal operations. […] Inflammatory bowel disease is another possible culprit. Both ulcerative colitis and Crohn disease can be associated with rectovaginal fistula. Crohn disease is more frequently associated with rectovaginal fistula because it causes transmural inflammation of the rectal wall. […] Rectovaginal fistulas are considered complex if they are large (2.5 cm), high, or caused by inflammatory bowel disease. Recurrent fistulas are also considered complex due to their association with tissue scarring and decreased blood supply. […] Due to the abnormal surrounding tissue, high location, and large size of complex fistulas, attempts at local repair are fraught with failure. The unhealthy tissue must be removed and new, viable tissue introduced to correct the problem. This is usually accomplished with abdominal resection procedures or tissue interposition techniques. […] Management of rectovaginal fistulas in patients with Crohn disease has improved secondary to advances in medical therapy. Control of inflammation has allowed some patients to be treated with local repair techniques.

• #45 Rectovaginal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2967329/

  Operative trauma can result in rectovaginal fistula. Low fistulas may be the result of anorectal and vaginal operations. […] Inflammatory bowel disease is another possible culprit. Both ulcerative colitis and Crohn disease can be associated with rectovaginal fistula. Crohn disease is more frequently associated with rectovaginal fistula because it causes transmural inflammation of the rectal wall. […] Rectovaginal fistulas are considered complex if they are large (2.5 cm), high, or caused by inflammatory bowel disease. Recurrent fistulas are also considered complex due to their association with tissue scarring and decreased blood supply. […] Due to the abnormal surrounding tissue, high location, and large size of complex fistulas, attempts at local repair are fraught with failure. The unhealthy tissue must be removed and new, viable tissue introduced to correct the problem. This is usually accomplished with abdominal resection procedures or tissue interposition techniques. […] Management of rectovaginal fistulas in patients with Crohn disease has improved secondary to advances in medical therapy. Control of inflammation has allowed some patients to be treated with local repair techniques.

• #46 da Vinci Assisted Take Down of a Rectovaginal Fistula Through a Posterior Vaginectomy – CSurgeries

  https://csurgeries.com/video/da-vinci-assisted-take-down-of-a-rectovaginal-fistula-through-a-posterior-vaginectomy/

  A rectovaginal fistula (RVF) is an epithelial lined tract between the rectum and vagina. This can result in recurrent urinary tract or vaginal infections, but also creates a significant psychosocial burden for the patient. […] Unfortunately, due to the individual complexities of these patients, they are difficult to manage despite the numerous surgical options presently described. Generally RVFs are classified as low, middle or high, due to the location of the rectal and vaginal opening. Due to this, both low and middle RVFs may be approached via anal, perineal or vaginal routes. Where as high RVFs, which have their vaginal opening near the cervix, generally require an abdominal approach for repair. […] Traditionally for high RVFs patients underwent open surgery; however, minimally invasive surgery has recently been widely accepted as the preferred approach. Although surgeons are becoming more facile with these approaches, both pelvic surgery and a reoperative abdomen still impose significant technical difficulties. […] Main advantage was the enhanced magnification of the Robot, which improved visualization and allowed access into an uninflamed, virgin plane, resulting in minimal loss of vaginal length.

• #47 Rectovaginal fistula and perineal breakdown | Obgyn Key

  https://obgynkey.com/rectovaginal-fistula-and-perineal-breakdown-2/

  Perineal body defects and rectovaginal fistulas (RVFs) are part of a spectrum of conditions that impact the posterior pelvic floor. […] Surgical management of these various defects requires a clear understanding of the anatomy of the distal portion of the posterior vaginal wall, the perineal body, the ASs, the rectum, and the anal canal. […] The surgical anatomy of the posterior pelvic floor remains an area of controversy among surgeons and anatomists. […] RVF is a congenital or acquired epithelialized tract between the rectum and the vagina. […] RVFs are classified according to their location and size; careful attention to both features allows determination of the approach for surgical repair. […] Another method of classification is based on the underlying cause of the fistula, which will be a better predictor of the ultimate success of the repair, as it takes into consideration the integrity of the local tissue and the health of the patient.

• #48 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  With regards to inflammatory bowel disease, RVFs are most commonly seen in Crohns disease and rarely in ulcerative colitis. […] The other classification (simple vs complex) primarily differentiates the RVF on whether it will be amenable to a local repair vs a more complicated underlying pathogenesis that will require resection, interposition grafts, and/or diversion. […] To optimize outcomes, it is important to ensure that any associated perineal sepsis has resolved completely before attempting an operative repair. […] The anatomy of the individual patient and the fistula itself are the foremost factors in determining which procedure to perform.

• #49 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  With regards to inflammatory bowel disease, RVFs are most commonly seen in Crohns disease and rarely in ulcerative colitis. […] The other classification (simple vs complex) primarily differentiates the RVF on whether it will be amenable to a local repair vs a more complicated underlying pathogenesis that will require resection, interposition grafts, and/or diversion. […] To optimize outcomes, it is important to ensure that any associated perineal sepsis has resolved completely before attempting an operative repair. […] The anatomy of the individual patient and the fistula itself are the foremost factors in determining which procedure to perform.

• #50 Operative considerations for rectovaginal fistulas

  https://www.wjgnet.com/1948-9366/full/v7/i8/133.htm

  With regards to inflammatory bowel disease, RVFs are most commonly seen in Crohns disease and rarely in ulcerative colitis. […] The other classification (simple vs complex) primarily differentiates the RVF on whether it will be amenable to a local repair vs a more complicated underlying pathogenesis that will require resection, interposition grafts, and/or diversion. […] To optimize outcomes, it is important to ensure that any associated perineal sepsis has resolved completely before attempting an operative repair. […] The anatomy of the individual patient and the fistula itself are the foremost factors in determining which procedure to perform.

• #51 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

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

  Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. […] The authors of the studies regarding the main cause of unsatisfactory treatment results see the presence of persistent inflammation, which triggers a prolonged wound healing and as a consequence the excessive deposition of extracellular matrix further hindering recovery. […] The choice of the surgical method of RVF treatment is influenced by this classification, the history of surgeries, the integrity of the anal sphincters and the quality of the surrounding tissues, which are often dependent on the cause of the fistula formation.

• #52 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

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

  Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. […] The authors of the studies regarding the main cause of unsatisfactory treatment results see the presence of persistent inflammation, which triggers a prolonged wound healing and as a consequence the excessive deposition of extracellular matrix further hindering recovery. […] The choice of the surgical method of RVF treatment is influenced by this classification, the history of surgeries, the integrity of the anal sphincters and the quality of the surrounding tissues, which are often dependent on the cause of the fistula formation.

• #53 Perioperative Factors Affecting the Healing of Rectovaginal Fistula

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

  The factors involved in the pathogenesis of CD are transforming growth factor β, TNF and IL-13 in the inflammatory infiltrate, which induce the epithelial–mesenchymal transition and the upregulation of matrix metalloproteinases, which may lead to the formation of a fistula. […] In a study by de La Poza et al., no influence of the location and clinical presentation of CD on the response to treatment of genital fistulae was observed. […] Therefore, the probable cause of poorer fistula repair results in women operated by abdominal access was not only a large number of comorbidities but also an older age. […] The use of MSCs may therefore be a promising strategy in the treatment of lesions caused by irradiation and regeneration of tissue damage. […] The healing effect of RVF appears to be influenced by estrogens affecting vaginal trophism.

• #54 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. […] The presence of a deflecting stoma increased the rate of fistula healing after local procedures. […] 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.

• #55 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. […] The presence of a deflecting stoma increased the rate of fistula healing after local procedures. […] 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.

• #56 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. […] The presence of a deflecting stoma increased the rate of fistula healing after local procedures. […] 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.

• #57 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. […] The presence of a deflecting stoma increased the rate of fistula healing after local procedures. […] 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.

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

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

  The main treatment for rectovaginal fistula is surgery. The problem can be resolved with appropriate surgery performed by a colorectal surgeon. […] Several techniques have been identified for the treatment of rectovaginal fistula. One of these is the application of a special staple resembling an OTSC (Over-The-Scope Clip) colonoscopically to close the fistula. […] Although attempts have been made to heal rectovaginal fistulas using special tissue adhesives called fibrin glue, success has only been achieved in about 30% of cases. […] 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.

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

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

  The main treatment for rectovaginal fistula is surgery. The problem can be resolved with appropriate surgery performed by a colorectal surgeon. […] Several techniques have been identified for the treatment of rectovaginal fistula. One of these is the application of a special staple resembling an OTSC (Over-The-Scope Clip) colonoscopically to close the fistula. […] Although attempts have been made to heal rectovaginal fistulas using special tissue adhesives called fibrin glue, success has only been achieved in about 30% of cases. […] 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.

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

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

  The main treatment for rectovaginal fistula is surgery. The problem can be resolved with appropriate surgery performed by a colorectal surgeon. […] Several techniques have been identified for the treatment of rectovaginal fistula. One of these is the application of a special staple resembling an OTSC (Over-The-Scope Clip) colonoscopically to close the fistula. […] Although attempts have been made to heal rectovaginal fistulas using special tissue adhesives called fibrin glue, success has only been achieved in about 30% of cases. […] 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.

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

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

  The main treatment for rectovaginal fistula is surgery. The problem can be resolved with appropriate surgery performed by a colorectal surgeon. […] Several techniques have been identified for the treatment of rectovaginal fistula. One of these is the application of a special staple resembling an OTSC (Over-The-Scope Clip) colonoscopically to close the fistula. […] Although attempts have been made to heal rectovaginal fistulas using special tissue adhesives called fibrin glue, success has only been achieved in about 30% of cases. […] 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.

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

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

  The main treatment for rectovaginal fistula is surgery. The problem can be resolved with appropriate surgery performed by a colorectal surgeon. […] Several techniques have been identified for the treatment of rectovaginal fistula. One of these is the application of a special staple resembling an OTSC (Over-The-Scope Clip) colonoscopically to close the fistula. […] Although attempts have been made to heal rectovaginal fistulas using special tissue adhesives called fibrin glue, success has only been achieved in about 30% of cases. […] 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.

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

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

  The endorectal advancement flap is a method applied through the anal route. […] In classical fistula surgery, as done in traditional methods, the cutting of all muscles until reaching the fistula can also be considered. […] For high-positioned fistulas, an abdominal approach is generally preferred. […] The opening of a stoma is a approach that can be considered at every stage in the treatment of rectovaginal fistula. […] The duration of the surgery can vary between 20 minutes to 180 minutes, depending on factors such as the technique applied, the surgeons experience and dexterity in this field, the presence of obesity in the patient, and the presence of fibrosis due to previous surgeries.

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

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

  The endorectal advancement flap is a method applied through the anal route. […] In classical fistula surgery, as done in traditional methods, the cutting of all muscles until reaching the fistula can also be considered. […] For high-positioned fistulas, an abdominal approach is generally preferred. […] The opening of a stoma is a approach that can be considered at every stage in the treatment of rectovaginal fistula. […] The duration of the surgery can vary between 20 minutes to 180 minutes, depending on factors such as the technique applied, the surgeons experience and dexterity in this field, the presence of obesity in the patient, and the presence of fibrosis due to previous surgeries.

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

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

  The endorectal advancement flap is a method applied through the anal route. […] In classical fistula surgery, as done in traditional methods, the cutting of all muscles until reaching the fistula can also be considered. […] For high-positioned fistulas, an abdominal approach is generally preferred. […] The opening of a stoma is a approach that can be considered at every stage in the treatment of rectovaginal fistula. […] The duration of the surgery can vary between 20 minutes to 180 minutes, depending on factors such as the technique applied, the surgeons experience and dexterity in this field, the presence of obesity in the patient, and the presence of fibrosis due to previous surgeries.

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

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

  The endorectal advancement flap is a method applied through the anal route. […] In classical fistula surgery, as done in traditional methods, the cutting of all muscles until reaching the fistula can also be considered. […] For high-positioned fistulas, an abdominal approach is generally preferred. […] The opening of a stoma is a approach that can be considered at every stage in the treatment of rectovaginal fistula. […] The duration of the surgery can vary between 20 minutes to 180 minutes, depending on factors such as the technique applied, the surgeons experience and dexterity in this field, the presence of obesity in the patient, and the presence of fibrosis due to previous surgeries.

• #67 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. […] RI-RVF is a complex anorectal pathology that has a significant impact on the quality of life of patients. […] 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. […] The Singapore flap presents a highly vascularized tissue flap that is suitable for reconstruction, thereby promoting healing and minimizing the likelihood of recurrence. […] A multidisciplinary team consisting of colorectal surgeons, plastic surgeons, and urogynecologists is crucial for effective management of rectovaginal fistulas. […] 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.

• #68 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. […] RI-RVF is a complex anorectal pathology that has a significant impact on the quality of life of patients. […] 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. […] The Singapore flap presents a highly vascularized tissue flap that is suitable for reconstruction, thereby promoting healing and minimizing the likelihood of recurrence. […] A multidisciplinary team consisting of colorectal surgeons, plastic surgeons, and urogynecologists is crucial for effective management of rectovaginal fistulas. […] 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.

• #69 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

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

  One of the difficulties in achieving high success rates in rectovaginal fistula surgery may be related to operating in a high-pressure organ, with failure driven by the dynamic forces required for the inevitable bowel motion the patient must have. […] Understanding these mechanisms is crucial to operating in this part of the body, and being able to identify defecatory dysfunction, a common cause of excess pressure generation, may also improve healing. […] From a colorectal perspective, the principles of treatment of a rectovaginal fistula include determining preoperative continence and ensuring optimal operating conditions, optimizing tissue quality, general health, and nutritional status. […] It is also important to keep the rectal pressure down, as the recurrence is likely to be derived from pressure on the rectal side of the repair. […] In Crohn’s disease, liaison with the treating gastroenterologist is crucial and repair should only be attempted when Crohn’s disease is medically controlled and in remission.

• #70 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

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

  One of the difficulties in achieving high success rates in rectovaginal fistula surgery may be related to operating in a high-pressure organ, with failure driven by the dynamic forces required for the inevitable bowel motion the patient must have. […] Understanding these mechanisms is crucial to operating in this part of the body, and being able to identify defecatory dysfunction, a common cause of excess pressure generation, may also improve healing. […] From a colorectal perspective, the principles of treatment of a rectovaginal fistula include determining preoperative continence and ensuring optimal operating conditions, optimizing tissue quality, general health, and nutritional status. […] It is also important to keep the rectal pressure down, as the recurrence is likely to be derived from pressure on the rectal side of the repair. […] In Crohn’s disease, liaison with the treating gastroenterologist is crucial and repair should only be attempted when Crohn’s disease is medically controlled and in remission.

• #71 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

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

  One of the difficulties in achieving high success rates in rectovaginal fistula surgery may be related to operating in a high-pressure organ, with failure driven by the dynamic forces required for the inevitable bowel motion the patient must have. […] Understanding these mechanisms is crucial to operating in this part of the body, and being able to identify defecatory dysfunction, a common cause of excess pressure generation, may also improve healing. […] From a colorectal perspective, the principles of treatment of a rectovaginal fistula include determining preoperative continence and ensuring optimal operating conditions, optimizing tissue quality, general health, and nutritional status. […] It is also important to keep the rectal pressure down, as the recurrence is likely to be derived from pressure on the rectal side of the repair. […] In Crohn’s disease, liaison with the treating gastroenterologist is crucial and repair should only be attempted when Crohn’s disease is medically controlled and in remission.

• #72 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

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

  One of the difficulties in achieving high success rates in rectovaginal fistula surgery may be related to operating in a high-pressure organ, with failure driven by the dynamic forces required for the inevitable bowel motion the patient must have. […] Understanding these mechanisms is crucial to operating in this part of the body, and being able to identify defecatory dysfunction, a common cause of excess pressure generation, may also improve healing. […] From a colorectal perspective, the principles of treatment of a rectovaginal fistula include determining preoperative continence and ensuring optimal operating conditions, optimizing tissue quality, general health, and nutritional status. […] It is also important to keep the rectal pressure down, as the recurrence is likely to be derived from pressure on the rectal side of the repair. […] In Crohn’s disease, liaison with the treating gastroenterologist is crucial and repair should only be attempted when Crohn’s disease is medically controlled and in remission.

• #73 Management of Complex Rectovaginal Fistula: Urogynecological Perspective

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

  One of the difficulties in achieving high success rates in rectovaginal fistula surgery may be related to operating in a high-pressure organ, with failure driven by the dynamic forces required for the inevitable bowel motion the patient must have. […] Understanding these mechanisms is crucial to operating in this part of the body, and being able to identify defecatory dysfunction, a common cause of excess pressure generation, may also improve healing. […] From a colorectal perspective, the principles of treatment of a rectovaginal fistula include determining preoperative continence and ensuring optimal operating conditions, optimizing tissue quality, general health, and nutritional status. […] It is also important to keep the rectal pressure down, as the recurrence is likely to be derived from pressure on the rectal side of the repair. […] In Crohn’s disease, liaison with the treating gastroenterologist is crucial and repair should only be attempted when Crohn’s disease is medically controlled and in remission.

• #74 Rectovaginal Fistula | SpringerLink

  https://link.springer.com/10.1007/978-3-031-19598-3_46

  A rectovaginal fistula (RVF) is an abnormal communicating tract between the epithelialized surfaces of the rectum and vagina that is formed as a consequence of injury or inflammation. The etiologies are vast, ranging from obstetric trauma to inflammatory bowel disease; therefore, several modalities exist for both workup and treatment. […] Given the inherent diversity in RVF pathophysiology, this chapter will review various considerations and tools to utilize in approaching individualized cases. Diagnosis should comprise of a thorough history and targeted physical exam, along with imaging and/or direct visualization. […] Significant emphasis is placed on the careful and thoughtful extent of multidisciplinary planning to diagnosis and address rectovaginal fistulas and their underlying etiology.

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