Benign rectovaginal fistulas

Benign rectovaginal fistulas have a high rate of treatment failure and involve difficult therapeutic decisions. They appear in the lower vagina, result from trauma, and are small in size, making them accessible to simple treatment. Surgery can be performed from a vaginal approach, with conversion of the fistula into a third-degree perineal tear, followed by repair of the perineal body and canal anal. These fistulas can also be managed from a transanal approach, using the endorectal advancement flap technique. Complex fistulas, defined by aetiology (IBD, radiation, enteritis, cancer, and surgery), that are located in the upper vagina or are large require more extensive and sophisticated surgery, such as a combined abdominoperineal approach and muscle flap technique. Among the numerous techniques described for the treatment of rectovaginal fistulas, the authors emphasize those currently used by the most experienced teams of colorectal and gynaecological surgeons.