Multidisciplinary Approach to Evaluation of Rectovaginal Fistulas.

Thorough evaluation of a rectovaginal fistula (RVF) is essential to optimize surgical repair. The underlying cause should be addressed and treated, which can affect the timing as well as approach to repair. It is imperative to be well-prepared as the highest chance of successful closure occurs during the initial repair attempt. Our objective is to demonstrate how multidisciplinary colorectal surgery and urogynecology teams use specific methods during exam under anesthesia to evaluate a complex RVF and optimize surgical approach to repair. Anesthesia may be provided with monitored anesthesia care and posterior perineal block. This pain control allows for a wide range of techniques to evaluate the fistula, using anoscopy, fistula probe, hydrogen peroxide, and sigmoidoscopy. Additionally, the teams show how curettage and subsequent seton placement can encourage closure by secondary intention and decrease the risk of abscess formation, respectively.