Multidisciplinary Approach to Evaluation of a Complex Rectovaginal Fistula

Objectives: Our objective is to demonstrate how multidisciplinary colorectal surgery and urogynecology teams use specific methods during exam under anesthesia to evaluate a complex rectovaginal fistula (RVF) and optimize surgical approach to repair.

Methods: Urogynecology and colorectal teams collaborate during an exam under anesthesia for evaluation of a complex RVF. They use a wide range of techniques to evaluate the fistula, including anoscopy, fistula probe, hydrogen peroxide, and sigmoidoscopy. Additionally, the teams show how curettage and subsequent seton placement can encourage closure by secondary intention while decreasing abscess formation.

Clinical Relevance: Thorough evaluation of a complex RVF is essential to optimize surgical repair. The underlying cause should be addressed and treated, which can affect the timing as well as approach to repair. It is imperative to be well-prepared as the highest chance of successful closure occurs during the initial attempt.