EP684 - Meeting in the Middle: A Combined Transvaginal and Transrectal Repair for Rectovaginal Fistulas

Sunday, May 10, 2026

4:17 PM - 4:22 PM ET

ePoster Presenter(s)

Yuen-Joyce Liu, MD

Resident
University of Connecticut
University of Connecticut
Farmington, CT, United States

Disclosure information not submitted.

Author(s)

AG

AYOOLAMIDE N. GAZAL, MD

Fellow Physician
Saint Francis Hospital and Medical Center
Hartford, Connecticut, United States

Disclosure information not submitted.
RM

Raul Mendelovici, MD

Female Pelvic Medicine & Reconstructive Surgery, Urogynecology and Recon
Saint Francis Hospital and Medical Center
Hartford, Connecticut, United States

Disclosure information not submitted.

Senior Author(s)

RS

Rachel B. Scott, DO (she/her/hers)

Chief of Colon and Rectal Surgery St. Francis Hospital
Colon and Rectal Surgeons of Greater Hartford
St. Francis Hospital and Medical Center
West Hartford, CT, United States

Disclosure information not submitted.

Purpose/Background: Rectovaginal fistulas (RVFs) are defined as low rectal or anal fistulas that epithelialize to the vagina. They can be highly distressing, often presenting with the passage of stool per vagina. The most common causes of RVFs include obstetric injury followed by infection, Crohn’s disease, and malignancy. Surgical repair remains the primary treatment, though approaches vary and include transvaginal, transperineal, and transrectal techniques.

Current clinical practice guidelines from the American Society of Colon and Rectal Surgeons recommend transrectal repair; however, this recommendation is based on low-quality evidence. While the surgical approach is typically tailored to the individual patient, no single approach has been shown to be superior. To date, despite multiple studies analyzing surgical techniques for RVF repair, there has been no analysis of a combined transvaginal and transrectal approach. Here, we present a novel technique that incorporates both transvaginal and transrectal repair in the management of rectovaginal fistulas.

Methods/Interventions: We conducted a retrospective review of medical records from an urban, single-institution tertiary care center between 2018 and 2025. Patients who underwent RVF repair using a combined approach by colorectal surgery (transrectal) and gynecology (transvaginal) were included. Collected variables included BMI, smoking status, ASA classification, recurrence, and days from surgery to last follow-up.

Results/Outcomes: A total of nine patients underwent the combined RVF repair approach. Three patients are still within the immediate postoperative follow-up window and have not yet returned for evaluation. Among the remaining six patients, none experienced recurrence during the study period. The mean duration from surgery to the last follow-up was 92 days (range, 14–282 days). No patients had a history of smoking, and the mean BMI was 26.6 kg/m².

Conclusion/Discussion: This small retrospective case series demonstrated no recurrences up to 92 days postoperatively (range, 14–282 days). Rectovaginal fistulas are relatively uncommon, with reported recurrence rates ranging from 50% to 85%. Patients often require multiple procedures to achieve complete healing. Prior to this study, no combined transvaginal and transrectal approach had been described. A limitation of this study is its small sample size; however, data collection remains ongoing. Given our 0% recurrence rate compared with previously reported outcomes, a combined approach involving both colorectal surgery and gynecology should be considered a potential standard of care.