A 20-year experience of rectovaginal fistula management in a tertiary university hospital in Thailand

Objective: The purpose of this study was to determine etiology, treatment and outcome of patients with rectovaginal fistula (RVF) who were treated in a tertiary university hospital in Thailand. Material and Method: The authors retrospectively reviewed the medical records of patients with RVF treating from 1994 to 2013 at the Faculty of Medicine Siriraj Hospital. Data were recorded including patient’s demographics, etiology, treatment and outcome. Results: This study included 108 patients with median age of 55 years (range 24 to 81). Radiation injury was the most common cause of RVF (44%) followed by direct invasion of rectal or gynecologic malignancies (20%), postoperative complication (16%) (notably from 10 low anterior resections, 5 transabdominal hysterectomies, 1 stapled hemorrhoidopexy and 1 injection sclerotherapy for hemorrhoid) and obstetric injury (11%). Diverting colostomy was the most frequent operation performed for both radiation-related RVF and malignancy-related RVF. Most operation-related RVF were healed after fecal diversion with or without either local repair or major resection. All obstetric-related RVFs were successfully treated by local tissue repair with or without anal sphincteroplasty. Conclusion: Radiation injury and advanced pelvic malignancies were two most common causes of RVF in this study. Fecal diversion can be either initial operation or definite treatment in most patients with RVF. Surgical correction resulted in good outcomes for postoperative RVF and obstetric-related RVF.