Rectovaginal fistula combined with fecal incontinence represents one of the more complex conditions encountered in colorectal and pelvic floor surgery. In this expert lecture, Steven D. Wexner presents an in-depth discussion of the evaluation and management of patients with rectovaginal fistula and associated continence problems.

The presentation focuses on understanding the underlying pathology before selecting treatment. A detailed clinical history, physical examination, assessment of the fistula tract, evaluation of anal sphincter integrity, and identification of contributing factors are important components of comprehensive management. Previous pelvic or colorectal surgery, obstetric trauma, inflammatory disease, infection, radiation, and recurrent fistula formation may all influence treatment decisions.

A major focus is the relationship between fistula repair and fecal continence. While closure of the abnormal rectovaginal communication is an important objective, surgeons must also consider the functional status of the anal sphincter and pelvic floor. Patients with significant sphincter injury or dysfunction may require additional procedures or a staged approach to address continence and achieve satisfactory long-term results.

Steven D. Wexner discusses the principles behind choosing surgical techniques for simple and complex fistulas. Depending on the patient's anatomy and previous treatment history, different reconstructive strategies may be considered, including advancement flaps, local tissue repair, sphincter reconstruction, interposition techniques, or diversion for carefully selected patients. The lecture emphasizes that management should be individualized rather than based on a single universal procedure.

This educational video provides valuable insights for surgeons dealing with complex colorectal conditions, pelvic floor disorders, anorectal dysfunction, and recurrent fistulas. By combining anatomical assessment with functional evaluation, surgeons can develop a more comprehensive treatment plan aimed at fistula healing, restoration of continence, prevention of recurrence, and improvement in quality of life.