Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization.

This study examines the use of laparoscopic upper rectovaginal mobilization to facilitate the transvaginal repair of recurrent rectovaginal fistulas. A 39-year-old female presented with fecal and gas incontinence consequent to an obstetrically related rectovaginal fistula with five unsuccessful transvaginal repairs over a 5-year period. Her condition was successfully treated by a transphincteric approach that combined an extensive laparoscopic dissection of the rectovaginal space from above with transvaginal dissection of the rectovaginal space from below to create complete mobilization between the two organs and to permit an excellent, tension-free closure of the rectal defect. Successful fistula closure and restoration of anal continence were achieved. The patient remains cured 18 months postsurgery. Laparoscopic mobilization of the upper rectovaginal septum followed by transvaginal division of the lower septum permits a more extensive mobilization and release of tension for fistula repair than that typically noted by the vaginal route alone.