Rectovaginal fistulas are classified as either simple or complex according to etiology, size, and location with respect to the rectovaginal septum (Table 13-2.1). Approximately 9 cm of the anterior rectal wall lies adjacent to the

Table 13-2.1. Classification of rectovaginal fistulas







Trauma or infection

Underlying disease (Crohn's, radiation, malignancy)

No previous repairs


vaginal wall below the peritoneal reflection. Low fistulas occur from any point distal to just above the dentate line and low in the vaginal fourchette (Figure 13-2.2), high fistulas occur behind or near the cervix in the apex of the vagina, middle fistulas occur somewhere between high and low, small fistulas are considered less than 2.5 cm.

Simple fistulas are low and small. They usually result from infection or trauma, have healthy, well-vascularized surrounding tissue, and are amenable to local repairs. Complex fistulas are large, high, and frequently recur because the scar has less vascularity. They may also be caused by IBD, cancer, or radiation, all of which are conditions involving unhealthy localized tissues.

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