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Rectovaginal Fistula Repair

Last updated April 2, 2018

Approved by: Maulik P. Purohit MD, MPH

Rectovaginal Fistula (RVF) Repair is a procedure that involves the surgical repair of an abnormal tract between the large intestine, rectum, and vagina, in women.

Background Information:

What are the other Names for the Procedure?

  • RVF Repair
  • Surgery for Rectovaginal Fistula

What is the Rectovaginal Fistula Repair surgical procedure?

Rectovaginal Fistula (RVF) Repair is a procedure that involves the surgical repair of an abnormal tract between the large intestine, rectum, and vagina, in women.

What part of the Body does the Procedure involve?

A Rectovaginal Fistula Repair procedure involves the vagina, rectum, surrounding tissue and blood vessels, and nerves within the perineum.

Why is the Rectovaginal Fistula Repair surgical procedure Performed?

The Rectovaginal Fistula Repair procedure is performed in women for the following reasons:

  • Preventing an infection within the vagina or urinary tract
  • Discomfort
  • Embarrassing foul-odors due to feces or gas passing through the vagina

What are some Alternative Choices for the Procedure?

A surgical repair is the best way to treat a Rectovaginal Fistula after medications and symptomatic treatments are found to be unsuccessful; unless, other health conditions or comorbidities are present.

What are the Recent Advances in the Procedure?

There have been advancements in surgical techniques to treat simple and complex Rectovaginal Fistulas (RVFs).

What is the Cost of performing the Rectovaginal Fistula Repair surgical procedure?

The cost of the Rectovaginal Fistula Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding an Rectovaginal Fistula Repair procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Rectovaginal Fistula Repair surgical procedure:

How is the Rectovaginal Fistula Repair surgical procedure Performed?

The Rectovaginal Fistula Repair procedure may be performed under general, regional, or local anesthesia.

  • For rectovaginal fistula that is situated lower (nearer to the anus or vagina), the tract may be repaired by approaching it either via the anus and rectum (lowermost portion of the large intestine, in transanal approach) or the vagina (transvaginal approach)
  • The fistula tract is identified and repaired by raising flaps of the wall tissue, curetting (removing tissue) the wall of the tract, and suturing the flaps in place
  • Rectovaginal fistulas that are situated higher up are repaired in a similar manner after approaching the fistula, by making an incision on the skin of the abdomen and dissecting through the layers

Where is the Procedure Performed?

A Rectovaginal Fistula Repair procedure is performed at a hospital.

Who Performs the Procedure?

The Rectovaginal Fistula Repair procedure is performed by any of the following medical personnel with or without assistance from an anesthesiologist:

  • Proctologist
  • Colon-rectal surgeon
  • General surgeon
  • Obstetrician-gynecologist

How long will the Procedure take?

The procedure may take an hour or so to perform, depending on the surgical approach.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Rectovaginal Fistula Repair procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Rectovaginal Fistula Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Rectovaginal Fistula Repair surgical procedure?

Before a Rectovaginal Fistula Repair, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • X-ray of the lower gastrointestinal tract
  • X-ray of the kidneys

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Rectovaginal Fistula Repair procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • What are the costs involved?

During the Rectovaginal Fistula Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Rectovaginal Fistula Repair procedure.

What are the possible Risks and Complications during the Rectovaginal Fistula Repair surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Rectovaginal Fistula Repair surgery are:

  • Excessive bleeding
  • Infection of the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Rectovaginal Fistula Repair surgical procedure?

  • After the Rectovaginal Fistula Repair procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
  • The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
  • Individuals are usually discharged from the hospital within 5-7 days of the procedure, if there are no complications

After the Rectovaginal Fistula Repair surgical procedure:

What are the possible Risks and Complications after the Rectovaginal Fistula Repair surgical procedure?

The possible risks and complications that may arise after a Rectovaginal Fistula Repair procedure are:

  • Excessive bleeding
  • Infection in the surgical wound
  • Incomplete healing of the fistula

What is the Prognosis after the Surgery?

A complete recovery from a Rectovaginal Fistula Repair procedure is usually achieved. The prognosis is excellent without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness such as nausea, vomiting, constipation, or diarrhea
  • Signs of an infection
  • Headache, muscle aches
  • Fever, feeling sick
  • Dizziness
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Rectovaginal Fistula Repair surgical procedure?

At home, the following post-operative care is recommended, after a Rectovaginal Fistula Repair procedure:

  • Slowly resume regular/daily activities as early as possible, which aids in faster recovery
  • Avoid all activities that are physically strenuous for about 6 weeks, or follow the physician’s advice
  • Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild unscented soap
  • Complete the course of prescribed medication as advised by your physician
  • Avoid constipation and stress during urination and bowel movements. Take stool softeners to prevent constipation (under advice of the physician)
  • Take antibiotic medication to help combat or prevent infection, per your physician’s advice
  • Resume driving 3 weeks after being discharged from the healthcare facility (as advised by your physician)
  • Individuals are advised to wait until the gastrointestinal tract begins properly functioning after surgery, before progressing on to a well-balanced diet. Also increase your fluid and fiber intake to prevent constipation and stress during bowel movements and urination

How long does it normally take to fully recover, from the Procedure?

It usually takes about 6 weeks to fully recover from the Rectovaginal Fistula Repair procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Rectovaginal Fistula Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • A hospital
  • A general surgeon, an obstetrician-gynecologist, a proctologist, or a colon-rectal surgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Rectovaginal Fistula Repair procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 21, 2015
Last updated: April 2, 2018