ASCRS Ch15 — Rectovaginal Fistula

Citation: Gurland BH, Vogel JD. "Rectovaginal Fistula." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 281–290 (PDF pp. 289–299 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Fifth chapter of Part II ("Anorectal Disease") — Chapter 14 preceded it and explicitly flagged this chapter as the related female-anatomy analog to RUF.

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Fifteenth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers rectovaginal fistula (RVF): classification (low/ high/middle by tract level, simple/complex), symptoms, etiology (obstetric injury, Crohn's disease — with detailed epidemiology and ACCENT-2 infliximab subset-analysis data, cryptoglandular, anastomotic/surgical complications incl. up to 10% post-LAR incidence, radiation), evaluation (history, awake/EUA exam, tampon test, imaging), and the full surgical technique ladder (perineal — episioproctotomy, transverse perineal repair; transrectal — ERAF, rectal sleeve advancement; vaginal; tissue transposition — Martius flap, gracilis interposition; bioprosthetic products; and abdominal approaches incl. Turnbull-Cutait delayed coloanal anastomosis).

Key content

Filed as a single new condition page, Rectovaginal Fistula — like Ch14, this chapter covers one cohesive clinical entity, so no split was needed. Cross-links added to Rectourethral Fistula (male-anatomy analog), Crohn Disease (RVF epidemiology/infliximab data), Colorectal Anatomy & Embryology (Denonvilliers' fascia/rectovaginal septum anatomy), Rectal Cancer and Colorectal Anastomotic Complications (post-LAR anastomotic-vaginal fistula), and three existing pages that had already flagged rectovaginal fistula in passing as a rare complication of their own procedures — Hemorrhoids (stapled hemorrhoidopexy), Rectal Prolapse Repair (STARR), and Local Excision of Rectal Neoplasms (anterior rectal lesion excision) — this chapter corroborates and contextualizes those existing mentions.

Limitations

• Textbook chapter, not primary literature; cited trial/series data (ACCENT-2 infliximab subset, stem cell series, surgical-technique success rates) are the chapter authors' synthesis, not independently re-verified.
• Explicitly states no single surgical technique has been shown superior — reported success rates (43–93% for ERAF alone) reflect substantial case-series heterogeneity, not head-to-head comparison.
• Obstetric-injury contribution to overall RVF incidence is explicitly flagged by the chapter as hard to pin down, with meaningfully different figures across cited series (13–24%).
• Congenital RVF, like congenital RUF in the preceding chapter, is out of scope (adult acquired RVF only).

Relevance

Fifteenth entry in the ASCRS ingest. Adds one new condition page, completing the wiki's coverage of both major acquired complex-fistula entities (RUF and RVF) back-to-back. Chapter 16 continues Part II with "Pilonidal Disease and Hidradenitis Suppurativa."