Episioproctotomy and primary reconstruction in the secondary treatment of perineal tears and rectovaginal fistulas

Rectovaginal fistulas are uncommon. The rectovaginal fistula is the most difficult fistula-in-ano for women. Conservative treatment is generally not successful. The surgical procedures are difficult to perform and are more complex than the treatment of typical cryptoglandular fistulas. Due to the anatomical location, interposition of well-vascularized tissue is necessary in order to rebuild the perineal body. The interposition of the puborectalis muscle sling is one of the most successful procedures. The combination of sphincter defect and rectovaginal fistula is very common. Combined sphincter repair and reconstruction of the perineal body is mandatory in the majority of the patients. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.