Gracilis muscle repair of rectovaginal fistula after restorative proctocolectomy

Gracilis muscle interposition flaps have been used to treat two patients with rectovaginal fistulas. The fistulas occurred following restorative proctocolectomy with a J-shaped ileal reservoir and ileoanal anastomosis. Attempts at local repair of the fistulas had failed. A diverting loop ileostomy was constructed simultaneously. Anterior sphincteroplasty was performed in one patient for associated incontinence. Excellent results were achieved in both patients. The fistulas have healed, and intestinal continuity has been re-established. This procedure can be useful to salvage a pelvic pouch complicated by a rectovaginal fistula.