title: The Noble-Mengert-Fish operation-revisited: a composite approach for persistent rectovaginal fistulas and complex perineal defects.
abstract: OBJECTIVE
  Our aims were to evaluate the full-thickness anterior rectal wall advancement flap in the treatment of primary and recurrent or persistent rectovaginal fistulas, evaluate the surgical exposure for composite repair of site-specific perineal defects, and categorize clinical manifestations of site-specific perineal defects caused by obstetric injury.
  
  
  METHODS
  This is a prospective study of all patients with fecal incontinence from rectovaginal septal defects and complex perineal obstetric injuries treated by the Noble-Mengert-Fish operation.
  
  
  RESULTS
  Thirty-four patients were classified into groups on the basis of site-specific perineal defects. Anatomic success was 94.2%. Functional success was excellent in 76.5%, good in 14.7%, fair in 5.9%, and poor in 2.9%.
  
  
  CONCLUSIONS
  The Noble-Mengert-Fish operation is effective for primary and recurrent or persistent rectovaginal fistulas. The circumanal surgical exposure permits concomitant repair of all perineal defects.
authors.affiliation: Section of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, St John's Mercy Medical Center, St Louis, Missouri, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Veronikis
authors.forename: D H
authors.initials: DH
authors.lastname: Nichols
authors.forename: C
authors.initials: C
authors.lastname: Spino
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010502:Perineum / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012006:Rectovaginal Fistula / Q000145:classification / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome