Rectovaginal fistulae must be divided into two groups. The first group consists of those that occur secondary to obstetric or gynecologic surgery for benign disease. The second group consists of those...

Rectovaginal fistulae must be divided into two groups. The first
group consists of those that occur secondary to obstetric or
gynecologic surgery for benign disease. The second group consists of
those that are associated with radiation therapy for pelvic
malignancy. Rarely is a diverting colostomy needed for fistulae from
benign disease. A transverse colostomy is always needed, however,
for pelvic cancer patients who have rectovaginal fistulae secondary
to irradiation. An outside blood supply, such as a muscular flap, is
not required for the repair of small rectovaginal fistulae secondary
to obstetric or gynecologic surgery, unless there is excessive
scarring or repeated attempts at closure have been unsuccessful.
Patients with rectovaginal fistulae associated with pelvic
irradiation, however, require a vascular flap to improve blood
supply to the irradiated tissues