©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2015; 7(8): 133-137
Published online Aug 27, 2015. doi: 10.4240/wjgs.v7.i8.133
Published online Aug 27, 2015. doi: 10.4240/wjgs.v7.i8.133
Operative considerations for rectovaginal fistulas
Kevin R Kniery, Eric K Johnson, Scott R Steele, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, Tacoma, WA 98431, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: The authors do not have any conflicts-of-interest to disclose.
Correspondence to: Kevin R Kniery, MD, General Surgery Resident, Department of Surgery, Division of Colorectal Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, United States. krkniery@gmail.com
Telephone: +1-504-6554276
Received: April 29, 2015
Peer-review started: April 29, 2015
First decision: May 14, 2015
Revised: May 26, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 27, 2015
Processing time: 125 Days and 5.1 Hours
Peer-review started: April 29, 2015
First decision: May 14, 2015
Revised: May 26, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 27, 2015
Processing time: 125 Days and 5.1 Hours
Core Tip
Core tip: There are general principles that will allow the best chance for resolution of a rectovaginal fistula with the least morbidity to the patient. Identifying and addressing the disease process that caused the fistula is critical, including medical management for Crohn’s, and resolving inflammation or sepsis with a seton. Then the exact anatomy of the fistula should be defined to determine operative approaches. The operative algorithm should begin with fistula plugs and local advancement flaps, if these fail more invasive options such as diversion, and interposition of healthy tissue should be pursued for complex and recurrent fistulas.