ABSTRACT
Women with symptoms of ano-or rectovaginal fistula (RVF) usually present with air or stool from the vagina or perineum. The initial step is always to ensure that any associated abscesses are adequately drained. If needed, an examination under anesthesia and seton placement are the first steps. Full evaluation is required to plan surgical management. The fistula location and etiology must be delineated. While most fistulae are cryptoglandular or obstetrical in origin, fistulae from diverticulitis, radiation, cancer, and Crohn’s disease require specific considerations which will be discussed later. For fistulae in the colon or upper rectum an abdominal approach is chosen and will not be discussed further. Similarly, fistulae from a low pelvic anastomosis will not be discussed. For low rectal or anal vaginal (or perineal) fistulae the approach can be transanal, transperineal, or transvaginal. The tissue must be soft before considering any repair. Therefore, a traumatic fistula such as from an obstetrical injury may require three to six months post-injury for the tissue to become appropriate for repair.
