Rectovaginal Fistulas and Intraoperative Bowel Injury

A rectovaginal fistula is an abnormal epithelium-lined communication between the rectum and vagina. There is nothing more physically and psychologically disabling than the aura of the incontinence of gas and fecal matter. There still remains controversy as to the best primary surgical corrective technique but an even more challenging decision is the approach to the patient who has failed corrective surgery. What is the role of a defunctioning stoma and when should more advanced surgical techniques be used? This section of the chapter outlines a practical and scientific approach to answer these difficult and controversial questions.