A holistic transperineal approach and successful treatment of primary obstetric rectovaginal fistula with fecal incontinence: Fistulectomy, sphincteroplasty and with or without bulbocavernosus muscle flap: Surgical pitfalls and prevention of recurrence. Randomized controlled trial

Introduction: A rectovaginal fistula (RVF) is an epithelium-lined abnormal tract between the rectum and the vagina.It is often a challenging problem for both the patients and to the surgeons. In literature, there is still debate regarding the best treatment options for rectovaginal fistulas. To assess the results of the treatment of rectovaginal fistulas with incontinence and impaired anal tonus using fistulectomy, sphincteroplasty with or without bulbocavernosus muscle (Martius) flap. Patients and Methods: A total of 22 consecutive patients with simple RVFs were included and assigned to transperineal repair. The patients were divided into two groups, group1: with Martius flap; group2: without Martius flap.Postoperatively, patients were followed up for one year. Results: All of the simple rectovaginal fistula cases are best treated with fistulectomy, sphincteroplasty. Martius flap has no effect in prevention of fistula recurrence with no statistically significant difference between group using Martius flap and group not using Martius flap. Conclusion: Repair of rectovaginal fistula with fistulectomy, sphincteroplasty without diversion is ideal for treatment of simple rectovaginal fistula. Treating the fistula without Martius flap does not affect outcome and may be treated without.