title: Presentation and management of rectovaginal fistulas after delivery.
abstract: BACKGROUND
  Obstetric trauma leading to rectovaginal fistula (RVF) formation results from perineal laceration and/or from prolonged ischemia and necrosis following obstructed labor. Due to modern obstetric care fistulas are rare in industrialized countries.
  
  
  METHODS
  Patients undergoing surgery for a RVF between January 2005 and December 2014 at the Department of Obstetrics and Gynecology, Tuebingen, Germany, were identified and their records were reviewed retrospectively.
  
  
  RESULTS
  Of 48 patients, 13 developed RVF of obstetric etiology. Parity ranged from 2 to 4. RVF repair was performed in all patients using a transvaginal approach: fistula excision and multilayer closure (7 of 13) with Martius flap interposition (1 of 7) and sphincteroplasty (5 of 13). One RVF closed spontaneously. Due to significant destruction of the anal canal, large RVF and RVF recurrence, 4 of the 13 patients needed a temporary protective ileostomy. Fistula closure was achieved in 12 of 13 patients.
  
  
  CONCLUSIONS
  The choice of RVF repair should be tailored to the underlying pathology and type of repair done previously and the patient's wishes.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany. christl.reisenauer@med.uni-tuebingen.de.
authors.forename: Christl
authors.initials: C
authors.lastname: Reisenauer
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D011247:Pregnancy; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Delivery; Perineal tear; Protective ileostomy; Rectovaginal fistula