title: German S3-Guideline: rectovaginal fistula.
abstract: BACKGROUND
  Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease.
  
  
  METHODS
  A systematic review of the literature was undertaken.
  
  
  RESULTS
  Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient.
  
  
  CONCLUSIONS
  In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature.
authors.affiliation: End- und Dickdarmpraxis, Essen, Germany. aommer@online.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Ommer
authors.forename: Alexander
authors.initials: A
authors.lastname: Herold
authors.forename: Eugen
authors.initials: E
authors.lastname: Berg
authors.forename: Alois
authors.initials: A
authors.lastname: Fürst
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiedeck
authors.forename: Marco
authors.initials: M
authors.lastname: Sailer
mesh_terms: D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery; D003131:Combined Modality Therapy; D019160:Endosonography / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D014621:Vagina / Q000601:surgery