Review of the surgical methods of rectovaginal fistula treatment

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Background: Rectovaginal fistula (RVF) is an abnormal connection between the rectum and the vagina, significantly impairing women’s quality of life and leading to psychological consequences. Despite advancements in various surgical techniques, a universally accepted treatment standard has yet to be established.Aim of the study: This review aims to summarize current strategies and emerging trends in the surgical management of RVF.Material and methods: A narrative review was conducted using PubMed and Google Scholar, with no publication year restrictions, up to February 2025. Keywords such as “rectovaginal fistula,” “surgery,” “Crohn’s disease,” and specific surgical techniques were combined using logical operators (AND, OR). Out of 2,578 records, 39 articles—original papers, meta-analyses, and case reports published in English—met the inclusion criteria and were analyzed.Results: Conservative management is recommended for small, minimally symptomatic fistulas. However, many patients ultimately require surgery, which varies depending on the fistula’s etiology and complexity. Minimally invasive procedures are preferred for simple, low-level fistulas. The Martius flap is suitable for low- and mid-level cases. Transabdominal approaches are reserved for high or radiation-induced fistulas and carry higher complication risks. Surgical decisions should be based on etiology, fistula size and location, anal sphincter function, tissue condition, and surgeon experience.Conclusions: RVF remains a challenging condition that requires individualized, multidisciplinary care. Future research should aim to refine surgical techniques, compare treatment outcomes by etiology and method, and include larger patient populations to support the development of robust clinical guidelines. Additionally, prospective comparative studies are essential to determine the most effective interventions for different RVF subtypes.

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