Rectovaginal Fistula · Repair + Approach

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Location/cause + sphincter + infection
   Location/cause? Sphincter involved? Active infection?
   • Acute abscess/active infection phase → Infection phase → seton/drainage
   • Low simple (obstetric), sphincter intact → Low simple → advancement flap
   • With sphincter defect (old obstetric) → Sphincter defect → sphincteroplasty + repair
   • Complex (Crohn's/radiation/high/recurrent) → Complex → tissue interposition/stoma
2. [End] Infection phase → seton/drainage
   With abscess/active infection → seton/drainage to control infection first, delayed repair; do not force repair during the infection phase.
3. [End] Low simple → advancement flap
   Low simple (obstetric), sphincter intact → transanal/transvaginal advancement flap repair (or transperineal); some tiny fistulas may be observed for spontaneous healing.
4. [End] Sphincter defect → sphincteroplasty + repair
   With sphincter defect → sphincteroplasty + fistula repair (perineal body reconstruction/episioproctotomy).
5. [End] Complex → tissue interposition/stoma
   Complex (Crohn's → biologics to control disease + seton; radiation; high/recurrent) → tissue interposition (gracilis), staged advancement flap; severe cases fecal diversion (stoma).

Source guidelines & references

• Rectovaginal fistula management (ASCRS; advancement flap/sphincteroplasty/tissue interposition)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways