Materiały źródłowe

• #1 Vaginal Fistula – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/tn10138

  A vaginal fistula is usually painless. But a fistula lets urine or feces pass into your vagina. This is called incontinence. And it can cause soiling problems that you cannot control. […] If you have a vaginal fistula, you will most likely need surgery to repair it. Before surgery, your doctor will see whether the tissue is healthy or needs to heal first. […] You may need medicine or wound care to heal the tissue before surgery. […] After fistula repair surgery, be sure to follow your doctor’s instructions. See your doctor right away if you have signs of infection, such as a fever, tenderness, swelling, or redness.

• #2 Fistulas | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/urogynecology-and-reconstructive-pelvic-surgery/fistulas

  A range of treatment options are available to restore the health and well-being of women with fistulas. […] Treatment will depend on the type and cause of the fistula and the patients treatment goals and preferences. Treatment options can range from close observation to surgical repair. […] Surgical repair of fistulas involves the removal of the fistula tract (passageway) and repair of the openings in the affected organs. Prior to surgery, its important to identify and treat the underlying cause of the fistula.

• #3 Vaginal fistula | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/vaginal-fistula

  Treatment for a vaginal fistula depends on factors such as the type of fistula you have, its size and whether the tissue that surrounds it is healthy. […] For a simple vaginal fistula or one with few symptoms, some procedures may help the fistula to heal on its own. A simple vaginal fistula may be one that’s small or one that’s not linked with cancer or radiation therapy. Procedures to help a simple vaginal fistula heal include: […] Most often, surgery is needed to treat a vaginal fistula. Before surgery can be done, any infection or swelling in tissue around the vaginal fistula needs to be treated. If tissue is infected, medicines called antibiotics can clear up the infection. If the tissue is inflamed due to a condition such as Crohn’s disease, medicines such as biologics are used to control the swelling.

• #3 Vaginal fistula | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/vaginal-fistula

  Surgery for a vaginal fistula aims to remove the fistula tract and stitch together healthy tissue to close the opening. Sometimes, a flap made of healthy tissue is used to help close the area. Surgery may be done through the vagina or stomach area. Often, a type of surgery that involves one or more small cuts can be done. This is called laparoscopic surgery. Some surgeons also control robotic arms with an attached camera and surgical tools. […] Surgery to repair a vaginal fistula often is successful, especially if you haven’t had the fistula for a long time. Still, some people need more than one surgery to get relief.

• #4 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.

• #4 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.

• #5 Vesicovaginal Fistula Treatments

  https://www.urologists.org/article/treatments/vesicovaginal-fistula-treatments

  A vesicovaginal fistula is an abnormal passageway between the bladder and the vagina that causes incontinence, allowing urine to drain directly into the vagina rather than through the urethra (the tube that conveys urine out of the body). Treatment depends on fistula size and location. […] Conservative treatments of vesicovaginal fistula promote closure of the fistula and prevent urine from flowing through. These include: Foley catheter: A one-to-two month catheterization of the bladder ensures that urine is drained from the bladder through the urethra and gives the fistula time to close. […] Estrogen therapy may help strengthen the vaginal wall and close the fistula. […] Conservative treatment options are best for patients with a fistula smaller than 3mm in diameter. If these aren’t successful, patients can move on to more invasive procedures.

• #5 Vesicovaginal Fistula Treatments

  https://www.urologists.org/article/treatments/vesicovaginal-fistula-treatments

  Conservative approaches work best when the fistula is diagnosed quickly (within seven days of its formation), less than 1 cm in diameter, not complicated by cancer or radiation, and responds well to bladder drainage within the first four weeks. […] In cases where prolonged bladder drainage fails to result in improvement, or when the abnormal passageway is large, complex, and stubborn, the fistula is not likely to resolve on its own and will require more invasive treatments. […] When treating the fistula, success rates depend on the severity of the condition and how long it has been present. Those with fistulas smaller than 1 cm who undergo conservative and minimally invasive treatments have a recovery rate as high as 80 percent. With surgery, rates can be even higher: The transvaginal approach has success rates ranging from 82 to 100 percent, while abdominal approaches have success rates between 85 and 90 percent. If a fistula is large and fails to respond to initial surgery, multiple surgeries may be required for long-term success.

• #6 Vaginal Fistula: Types, Symptoms, Causes, Treatments

  https://www.webmd.com/women/what-is-a-vaginal-fistula

  Some fistulas may heal on their own. If its a small bladder fistula, your doctor might want to try putting a small tube called a catheter into your bladder to drain the pee and give the fistula time to heal by itself. […] They might also use a special glue or plug made of natural proteins to seal or fill the fistula. They can also give you an antibiotic to treat an infection caused by the fistula. […] Many people who have fistulas need surgery. What kind of surgery you get depends on the type of fistula and where it is. It could be laparoscopic, in which your doctor makes small cuts (incisions) and inserts cameras and tools. Or it could be abdominal surgery, where you get a regular incision with a tool called a scalpel. […] For a vaginal fistula that connects to your rectum, your doctor might: […] Sew a special patch over the fistula […] Take tissue from another place in your body to close it […] Fold a flap of healthy tissue over the fistula […] Fix the muscles of your anus if theyre damaged.

• #7 Vaginal Fistula: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22079-vaginal-fistula

  Surgery can close a fistula. […] Treatment depends on where the fistula is and the type. Some small fistulas heal on their own with conservative treatments like: […] Most times, surgery is necessary to close the opening. […] A surgeon may use your own tissue, lab-made tissue or a surgical mesh patch to close or seal the opening. […] As many as 9 in 10 women with a vaginal fistula have a complete recovery after surgery. […] Yes. Sometimes, a small vesicovaginal fistula or rectovaginal fistula can go away with antibiotics and a catheter to drain pee away from the fistula (giving it time to heal). […] Surgical treatments for vaginal fistulas are highly successful. Most women experience a full recovery and no longer have symptoms. […] Surgery to close a fistula is highly successful and your risk of developing one again is small.

• #8 Vesicovaginal and Ureterovaginal Fistula Treatment & Management: Approach Considerations, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/452934-treatment

  No medical therapy is available for the management of vesicovaginal and ureterovaginal fistula. However, conjugated estrogen (oral or transvaginal) helps vaginal tissues become softer and more pliable for upcoming fistula repair. This is especially important for postmenopausal women and women with atrophic vaginitis. […] For a small fistula, an initial trial of urethral catheter drainage may be attempted for 4-6 weeks. However, catheter drainage and/or fulguration of the edges of the fistula tract less often results in a cure. Small fistulae have a higher likelihood of healing with catheterization. […] Vesicovaginal and ureterovaginal fistulae recognized within 3-7 days after the causative operation may be repaired immediately via a transabdominal or transvaginal approach. […] In the past, surgical repair of any vesicovaginal fistula before 3 months was discouraged for fear of recurrence and inadequate healing. However, the principle of delayed repair is no longer absolute.

• #8 Vesicovaginal and Ureterovaginal Fistula Treatment & Management: Approach Considerations, Surgical Therapy, Preoperative Details

  https://emedicine.medscape.com/article/452934-treatment

  Use of platelet-rich plasma (PRP) as both a novel primary treatment for closure of vesicovaginal fistula and as an adjuvant treatment to improve surgical wound healing have shown promising outcomes in reported cases and small series. […] The main goal in correcting vesicovaginal fistula is to separate the fistulous communication between the bladder and the vagina. This can be accomplished by inserting interposing tissue between the 2 organs and obtaining a watertight tension-free closure. […] Persistent incontinence after an adequate period of watchful waiting requires open exploration and formal fistula repair. […] A history of previous failed repairs does not preclude transvaginal reconstruction. […] If ureteral reimplantation is necessary, dissect out the ureter prior to fistulectomy. Reimplant the ureter in the upper bladder wall after the fistula is closed with or without adjunct procedures such as a psoas hitch or boari flap. […] Complications associated with ureterovaginal fistula repair include urinary extravasation and ureteral stricture formation.

• #9 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  Treatment of patients with VVF must embrace their immediate and, in most cases, subsequent surgical management. […] If the diagnosis is established late and the fistula has epithelized, electrocoagulation of the mucosal layer and 24 weeks of catheterization may lead to closure. […] Fibrin sealant has been used as an adjunctive measure to treat VVF. […] The timing of intervention should aim to find the compromise between the wish to free the patient from urinary loss and to wait for the optimal conditions for closure. […] The classical strategy is a delayed repair, undertaken after 36 months to allow healing of any inflammation and edema. […] The arguments continue as to whether the abdominal or vaginal route is the most appropriate for fistula repair. […] Most gynecologic surgeons favor the vaginal approach.

• #9 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  The transabdominal OConnors operation has been the most accepted method of repair of supratrigonal fistula to date. […] VVF developed in radiated tissue should always be repaired using fresh blood supply such as flaps. […] In some cases, surgical repair of a VVF will fail repeatedly, probably due to existing pelvic malignancy, severe radiation damage, and/or large soft tissue loss, especially in the setting of obstetric fistula. […] For the above groups, urinary diversion, either in the form of a urinary conduit or a continent reservoir, can be considered. […] Very high or large VVFs either in close proximity to ureteric orifices or when associated with hydronephrosis, hydroureter, or urinary ascites or absent vaginal cuff are considered to be complex fistulas and require a transabdominal transvesical approach.

• #9 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  The successful management of such fistulas is largely dependent on judicious use of interposition flaps. […] Moreover, the laparoscopic repair of vesicovaginal fistula without opening the bladder and using intracorporeal suturing and omentum interpositioning is a feasible procedure in selected patients. […] Successful robotic VVF repair was first reported in 2005. […] It is doubtful that a single procedure will emerge as the optimal surgery for all patients with VVF, given the variability in the nature of the condition, the patients on whom it occurs, and the expertise of the individual surgeon.

• #10 Vesicovaginal Fistula: Etiology, Diagnosis, and Treatment

  https://www.urology-textbook.com/vesicovaginal-fistula.html

  A newly diagnosed vesicovaginal fistula after gynecological surgery may be cured by inserting an indwelling catheter for 34 weeks (success rate 1050%). The success is difficult to predict in individual cases; indicators of a good prognosis are early diagnosis and therapy within seven days, small fistulas of less than 1 cm in size, no loss of urine after inserting the bladder catheter, and no previous radiation treatment or cancer surgery. […] The time delay between fistula formation and surgical treatment is stressful for the patient. Uncomplicated fistula after pelvic surgery may be treated without delay. Fistula repair caused by prolonged obstructed labor should be delayed for three months to allow healing of the inflammatory and necrotic tissue reaction around the fistula. Vaginal estrogen application is recommended before surgery for postmenopausal women. Some authors recommend a delay of up to one year before repair of radiation therapy induced fistulas.

• #10 Vesicovaginal Fistula: Etiology, Diagnosis, and Treatment

  https://www.urology-textbook.com/vesicovaginal-fistula.html

  Vaginal surgical techniques are possible for uncomplicated and small vesicovaginal fistulas. The main advantage of the vaginal approach is the low postoperative morbidity. […] The abdominal approach is more risky for the patient. Still, it is necessary for fistulas of more than 2 cm in size, after irradiation, after failed repair, if there is a need for simultaneous abdominal surgery (ureteral injury or intestinal fistula), or if a too narrow vagina hinders the vaginal approach. […] Cystectomy is an option in vesicovaginal fistula due to advanced tumor disease or a contracted bladder after radiation therapy.

• #11 Treatment of Rectovaginal Fistula

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

  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. […] Anal sphincter damage might need a repair of sphincter muscles along with RVF repair. […] 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.

• #12 Vaginal Fistula: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/womens/urogynecology/vaginal-fistula/treatment

  Most vaginal fistulas require surgery in order to repair the irregular opening. The majority of these surgeries have positive outcomes. […] In order to close the abnormal opening, fistula surgery may be the only course of action. Your doctor will determine which type of surgery is best based on the type of fistula and your symptoms. A surgeon may use tissue from your own body, surgical mesh, or synthetic tissue to close up the opening. […] Surgical procedures for vaginal fistulas have a high success rate. The majority of patients make a full recovery and find relief from symptoms.

• #13 Fistula Treatment

  http://www.urocenterofnewyork.com/for-women/fistula/fistula-treatment/

  There are distinct differences between a vaginal and abdominal approach to fistula repair. All things being equal, the vaginal approach is far preferable for a number of reasons. Firstly, the surgery is done completely through the vagina so there is no visible scar. Secondly, the post-operative recovery is much easier and less painful without an abdominal incision and there is much less chance of wound infection and other complications. Further, blood loss is less and there is less chance that you will require a blood transfusion. […] In the hands of all but the most expert of fistula surgeons, the abdominal approach probably has a considerably higher success rate. Further, the vaginal approach can result in more vaginal scarring; it can shorten the vagina and cause painful intercourse (dyspaerunia). And in some women, the vagina is simply too small or the fistula is up too high for the surgeon to be able to adequately expose it. In these instances, an abdominal approach should be used.

• #14 Vaginal Fistula Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/obgyn/services/fistula-care

  We treat vesicovaginal fistulas through a minimally invasive procedure, entering through the vagina. We either surgically remove the connection between the bladder and vagina by sealing the two organs separately or by closing off the connection at the very top of the vagina. […] Occasionally, we may need to perform the minimally invasive procedure through your belly. We usually perform this laparoscopic procedure by making tiny incisions in the belly and placing a small camera and instruments through them. For complicated cases, we may use robotics to aid in the repair.

• #14 Vaginal Fistula Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/obgyn/services/fistula-care

  At Mount Sinai, our fistula experts are second to none in terms of surgical experience, patient care, and supportive services. We take a multidisciplinary and individualized approach to fistula care. […] We treat rectovaginal fistula by performing a multi-layer repair of the area between the rectum and the vagina. Most women have enough tissue in this area that we can place multiple layers between the previous defects in the rectum and the vagina to ensure that the fistula does not return. If you have large defects or have had multiple previous failed attempts at closing the fistula, we may need to use tissue flaps to aid in closure. We build these tissue flaps by moving part of the rectal mucosa downward to cover the defect or transplanting fat, muscle, or skin from areas on or near the outside of the vagina.

• #15 Vaginal Fistula: Rectovaginal and Vesicovaginal Fistula Fort Lauderdale, FL | Vaginal Trauma Boca Raton, FL

  https://www.urogyne.net/vaginal-fistula-urogynecologist-fort-lauderdale-miami-boca-raton-fl.html

  Initially, you may be prescribed antibiotics or other medications to heal any infection in the area. In some instances, your doctor might recommend waiting for a few months to see if the fistula may heal on its own. Wearing a bladder catheter for a few weeks may help a vesicovaginal fistula spontaneously heal. Often surgery may be necessary. Surgical options include: […] Most vaginal fistulas can be effectively repaired via a vaginal procedure. In an ambulatory surgery procedure, the fistula can be surgically buried with healthy tissue (Latzko procedure for vesicovaginal fistula) or entirely removed and the defect closed in layers (rectovaginal fistula). […] Use of a biologic tissue plug to seal the fistula and guide your body to heal around the plug for rectovaginal fistulas […] Patching up the fistula using a tissue graft obtained from adjacent healthy tissue […] Repairing sphincter muscles which may have been damaged due to the fistula may be needed to prevent incontinence […] In some rare or complex cases, a colostomy is also performed to divert your urine or stool through an opening in your abdomen while your fistula heals.

• #16 Rectovaginal fistula – Wikipedia

  https://en.wikipedia.org/wiki/Rectovaginal_fistula

  After diagnosing rectovaginal fistula, it is best to wait for around three months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix. A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally. […] Most rectovaginal fistulas will need surgery to fix. Medications such as antibiotics and Infliximab may be prescribed to help close the rectovaginal fistula or prepare for surgery.

• #17 Vesico-Vaginal Fistula – London Urology Specialists

  https://www.londonurologyspecialists.co.uk/vesico-vaginal-fistula/

  If the fistula defect is accessible (can be reached) through the vagina then this is often the preferred route as it avoids another operation through tour abdomen (stomach). The bladder and vagina are separated to allow each to be sewn closed individually. Urine (water) can find a route through the smallest of defects so in order to reduce the risk of the repair failing a flap of fat from one of your labia is tunnelled between the bladder and vagina repairs to form an interposition layer between the two lines of stitches. This is called a Martius fat pad. […] If the fistula defect cannot be reached through the vagina, the defect is too large, or the ureter (kidney) drainage is affected then the operation can be performed through the abdomen (stomach). This is usually performed through a Bikini line (Pfannensteil) incision. The bladder and vagina are separated to allow each to be sewn closed individually. In abdominal repairs fat from your stomach Omental interposition is brought down to separate the bladder and vagina layers. Following both vaginal and abdominal repairs a urethral and or abdominal catheter is left in place for 3-4 weeks to give time for the fistula to heal. The catheters drain into a collection bag on tour thigh. After this time a Cystogram dye X-ray is performed to check that the fistula is healed and the catheter is then removed.

• #18 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.

• #18 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

  The most commonly applied surgical procedures are simple fistulotomy, long-term seton, and rectal flap closure. […] The Martius flap was first described almost a century ago for urethrovaginal reconstruction. […] The procedure was later modified as a vascularized labium major adipose tissue flap and reported for use in RVF treatment. […] The reported overall success rate reached 50% in CD patients, with low morbidity and no negative effect on the Quality-of-life score. […] We suggest that MSC therapy should be considered earlier in the patient approach timeline, as well as combining a surgical attempt with local MSC application, rather than dividing these treatment options. […] We believe that MFAT-MSC application raises the overall success rate, with good patient compliance, possibly less postoperative pain, minimal additional effort, and no significant adverse effects.

• #19 Vaginal Fistula Treatments | Bladder & Bowel Community

  https://www.bladderandbowel.org/bladder/bladder-treatments/vaginal-fistula-treatments/

  Symptoms of a vaginal fistula can cause embarrassment to the sufferer but in many cases they can be treated effectively. […] Surgery will be offered in most cases but you may also be prescribed medication if your fistula was caused by infection. […] The majority of fistulas will need surgical intervention to full heal. […] The operation will involve either or both a gynaecology surgeon and colorectal surgeon depending on the type of fistula. […] The surgeon will remove the tract and close the opening by sewing healthy pieces of tissue together. […] This may involve: […] In very complex cases, a colostomy may be created to divert waste away from the fistula site to allow healing to take place. In most instances this is only a temporary measure and the colostomy will be reversed once the fistula is healed.

• #20 Rectovaginal fistula – St Mark’s The National Bowel Hospital

  https://www.stmarkshospital.nhs.uk/services-a-z/rectovaginal-fistula-delormes-rectal-advancement-flap/

  The use of a stoma has not been shown (in research performed to date) to be beneficial in helping a rectovaginal fistula to heal. However, the research examining this question is not of a very high quality and probably does not answer the question with much confidence. Many experts suggest that women have a stoma created in order to improve the chances that their fistula will heal after surgery. […] Remember, however: the majority of women with a rectovaginal fistula will be healed by surgery, even if more than one attempt is necessary.

• #21 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.

• #21 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.

• #22 Treatment of Rectovaginal Fistula

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

  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 endorectal AF for RVFs with various etiology ranges 41%-78%. […] The success rate of repeat flaps for failed attempt at fistula repair has been documented in 55%-93%. […] The success rate of this procedure ranges 53.1%-100%. […] The use of tissue interposition along with local repair improves the healing of RVF repair by inserting well-vascularized tissue into the rectovaginal septum. […] Abdominal repairs include fistula excision with multi-layered closure of the rectum and the vagina, accompanying with an interposition of well-vascularized omental tissue. […] 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.

• #23 Treatment for Vesicovaginal Fistula | University of Utah Health

  https://healthcare.utah.edu/urology/conditions/vesico-vaginal-fistula

  Your treatment plan depends on the cause and location of your fistula. Your urologist will work with you to find the best way to treat your condition: […] Surgery The surgical approach thats right for you depends on your fistulas location and your anatomy. We may use one of the following approaches for your surgery: […] We will insert surgical tools through your vagina to repair the fistula. […] We will make an incision in your abdomen to access and repair the fistula. […] Vesicovaginal fistula surgery is usually an outpatient procedure, so you can go home the same day. But you may need to stay in the hospital overnight if we make an incision in your abdomen. We use stitches and several layers of healthy tissue to close the fistula hole. You will have a catheter in your bladder for about three weeks in order to allow you to fully heal. Your total recovery time will depend on several factors, including your overall pain and the surgical approach. Most people take the full three weeks off work while the catheter is in place. […] Your surgeon will monitor your healing and manage any complications if they arise.

• #24 Fistula Treatment | OB/GYN: Obstetrics, Gynecology, and Nurse Midwifery | DHMC and Clinics

  https://www.dartmouth-hitchcock.org/obgyn/fistula-treatment

  Two common types of fistula are vesicovaginal fistula and rectovaginal fistula. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina. […] A rectovaginal fistula is an abnormal connection between the rectum and the vagina. It can occur after childbirth, surgery, and radiation treatment. […] We treat a fistula using vaginal, laparoscopic, or abdominal surgery: […] Surgery for a complex fistula is often performed through the abdomen. […] After your vesicovaginal fistula procedure your care may include: […] A recommendation from your provider to refrain from sexual intercourse for about 6 weeks.

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

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

  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.

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

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

  Like all major surgeries, surgical repair of vaginal fistulas comes with risks. These may include: […] Some surgeries fail to repair the fistula, while others do not heal properly or return. Other complications include: […] Vaginal fistulas describe openings between the vagina and other organs, such as the rectum, bowel, and bladder, which are not normally present. […] While some small fistulas may heal on their own, many require surgery to separate the organs. The steps involved in these operations will depend on the fistula’s severity, location, and complexity.

• #27 Vaginal fistula repair – Urogynecology & Pelvic Reconstructive Surgery | Northwell Health

  https://www.northwell.edu/obstetrics-and-gynecology/urogynecology-pelvic-reconstructive-surgery/treatments/vaginal-fistula-repair

  The success rate for fistula repair is high. However, any surgery comes with risks, which in this case include bleeding, infection and damage to the surrounding areas including the bladder, rectum and reproductive organs (such as the uterus and ovaries). […] After most fistula repairs, patients can expect minimal pain, but they may also have to use a catheter to urinate for up to two weeks.

• #28 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 implications of the Tuttle, Turnbull-Cutait, and Singapore approaches include a 2-week hospital stay, facilitating the delayed coloanal anastomosis, as well as a loop ileostomy reversal after the anastomosis has healed. […] Management of RI-RVF should be individualized. 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.

• #29

  https://link.springer.com/article/10.1007/s00384-022-04206-7

  The healing rate for initial fistula closure was 25.5%, but repeated procedures led to a final healing rate of 67.3%. Even when final healing of the fistula is accomplished, quality of life might remain affected, as demonstrated by our study and earlier ones. […] Our results show that patients who perceived persistent fistulation score numerically lower in all but two RAND-36 domains compared to patients who consider their RVF healed. Furthermore, both groups scored numerically lower than the general population in every domain. The reason for persistently lower RAND-36 scores even in patients with healed fistulation might be remaining pelvic dysfunction after repeated surgery. […] Although the initial healing rate for RVF repair was low, two-thirds of the patients in our study achieved fistula healing with repeated surgery. Fistulas of traumatic origin (obstetric and iatrogenic) had a significantly better prognosis compared with those of inflammatory-related origin (anastomotic, infectious, and Crohns). The low healing rate after index surgery might be an argument for more extensive procedures early on in the surgical strategy.

• #30 Colorectal-Vaginal Fistulas: Imaging and Novel Interventional Treatment Modalities

  https://www.mdpi.com/2077-0383/7/4/87

  Colovaginal and/or rectovaginal fistulas cause significant and distressing symptoms, including vaginitis, passage of flatus/feces through the vagina, and painful skin excoriation. These fistulas can be a challenging condition to treat. Although most fistulas can be treated with surgical repair, for those patients who are not operative candidates, limited options remain. […] In order to offer optimal treatment options to these patients, it is important to understand the imaging and anatomical features which may appropriately guide the surgeon and/or interventional radiologist during pre-procedural planning. […] Once diagnosis has been achieved, the management of patients with vaginal fistulas is as much determined by their etiology as by physical factors, including the size, location, and complexity of the tract. Given the overlap of this problem with fields such as obstetrics/gynecology, urology, and colorectal surgery, a multidisciplinary approach may be necessary for effective treatment. Although conservative management has been utilized in some cases, the vast majority of patients are treated surgically, with a new and evolving subset of patients receiving novel treatment with interventional assistance.

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