Single-incision transperineal repair of simple and recurrent rectovaginal fistula with a vital bulbocavernosus muscle flap

Background: Rectovaginal fistulas (RVFs) are abnormal epithelium-lined connections between the rectum and the vagina. RVFs may be simple or complex. This study analyzed the outcome of singleincision transperineal repair of simple RVFs with a vital bulbocavernosus muscle flap. Patients and methods: A total of 11 consecutive patients with simple and recurrent RVFs were included and assigned to single-incision transperineal repair with a vital bulbocavernosus muscle flap. Postoperatively, patients were followed up at the outpatient clinic or through telephone interviews with specific questionnaires to collect information on the status of fecal control, flatus, or fecal leakage from the vagina, and on the quality of personal and social life. Functional results were evaluated after 6 months by means of anal manometry and a questionnaire reflecting the symptomatic results, Wexner Incontinence Score and the Female Sexual Functional Index. Results: The mean hospital stay was 10.37 ± 1.12 days. The mean follow-up period was 8.81 ± 2.56 months. The results of mean anal pressure measurements postoperatively showed no significant differences compared with preoperative measurements. The results of pre-operative and pos-toperative Wexner Incontinence scores and Female Sexual Function Indices showed high significant postoperative improvements in all patients (P = 0.001). By the time of the last follow-up, there was no recurrence of RVF, and all patients reported normal fecal continence and had returned to a normal life. Conclusion: Although RVF is troublesome for surgeons, it can be cured using our procedure. It seems that this technique is both simple and effective, giving excellent anatomical and functional results without the need for a protecting stoma.