Surgical options for rectovaginal fistulas secondary to obstetrical injury

Obstetric injury is the most frequent cause of rectovaginal fistulas in many series. The fistulas are a result of an unrecognized fourth-degree laceration or a failed repair. It is clear from the mechanism of injury that a concomitant sphincter defect is frequently present. Therefore, attention must be paid to the patient's continence and anal sphincter status during the history and investigation. The choice of repair should be tailored to the fistula and status of the sphincter muscle. Several techniques are available without clear evidence of superiority of one technique.