Contributors: Dr. Jimmy Lin, Dr. Juana Hutchinson-Colas, Dr. Nell Maloney-Patel
Rectovaginal fistulas can occur for a number of reasons, including obstetric trauma, iatrogenic, radiation damage and Crohn’s disease. Symptoms range from asymptomatic to uncontrollable passage of gas or feces from the vagina leading to poor quality of life for some patients. For those patients whom surgery is indicated, there are several different approaches depending on the fistula etiology and previous attempts at repair. These range from simple fistulectomy to transabdominal repair with tissue interposition to Martius flap interposition. Our patient in the video had previously underwent multiple various repairs which failed to provide adequate resolution of her fistula and therefore presented for a Modified Martius flap repair. The benefit of such a repair is to provide neovascularity at the site of repair with minimal cosmetic effect.
Modified Martius flap for rectovaginal fistula
Repair of rectovaginal fistula after multiple failed attempts
Pre-existing dyspareunia (relative)
CT scan, digital rectal exam, vaginal exam, colonoscopy
vagina, introitus, rectum, rectovaginal septum, labial fat pad
Advantages: Interposition of healthy, vascularized tissue in the rectovaginal septum
Disadvantage: Impaired labial function, poor cosmesis
No conflicts to disclose.
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