Table 5 ASCRS treatment guidelines for RVF
Recommendation | Grade of recommendation |
|---|---|
Non-operative management is recommended for the initial management of obstetrical rectovaginal fistula and may also be considered for other benign and minimally symptomatic fistulas | Weak, based on low-quality evidence, 2C |
A draining seton may be required to facilitate resolution of acute inflammation or infection associated with rectovaginal fistulas | Strong, based on low-quality evidence, 1C |
Endorectal advancement flap, with or without sphincteroplasty, is the procedure of choice for most simple rectovaginal fistulas | Strong, based on low-quality evidence, 1C |
Episioproctotomy may be used to repair obstetrical or cryptoglandular rectovaginal fistulas associated with extensive anal sphincter damage | Strong, based on low-quality evidence, 1C |
A gracilis muscle or bulbocavernosus muscle (Martius) flap is recommended for recurrent or otherwise complex rectovaginal fistula | Strong, based on low-quality evidence, 1C |
High rectovaginal fistulas that result from complications of a colorectal anastomosis often require an abdominal approach for repair | Strong, based on low-quality evidence, 1C |
Proctectomy with colon pull-through or coloanal anastomosis may be required to repair radiation-related and recurrent complex rectovaginal fistula | Weak, based on low-quality evidence, 2C |