Surgical Repair Options

Dr. Ashok Kumar has special expertise in rectovaginal fistula surgery — one of his declared areas of specialist interest. Surgery is tailored to the fistula's location, size, aetiology (cause) and previous repair attempts.

Transanal Mucosal Advancement Flap

The most commonly used technique for low and mid-level RVFs. A flap of healthy rectal mucosa and muscle is raised and advanced to cover the internal (rectal) fistula opening. The vaginal opening is left open to drain. Success rate: 60–80% for primary repairs.

Transperineal Repair with Levatorplasty

For post-obstetric RVF associated with sphincter injury. The fistula is excised through a perineal incision, the sphincter is repaired (sphincteroplasty) and the levator ani muscles are reconstructed. This addresses both the fistula and any associated faecal incontinence. Success rate: 70–85%.

Tissue Interposition (Flap) Procedures

• Gracilis Muscle Flap — uses the gracilis muscle from the inner thigh; best for complex, irradiated or recurrent RVFs. Brings healthy vascularised tissue into the repair.
• Martius Flap — uses labial fat pad; less invasive than gracilis; useful for post-obstetric and post-surgical RVFs.
• Omental Flap — uses omentum (abdominal fat); requires laparotomy; used for high RVFs.

Defunctioning Stoma

A temporary diverting stoma (loop ileostomy or colostomy) is created before complex RVF repair to protect the repair by keeping stool away from the fistula site. It is reversed 2–3 months after confirmed healing on contrast imaging.