Author (Year)

Population (time period)

Method of repair

Number of patients

Diverting stoma?

Results

Follow-up

Quality of evidence

De Parades (2011) [1]

Rectovaginal fistula (2003–2008)

Endorectal advancement flap with muscular plication

23 (10 initial, 13 recurrent)

No

15 (65 %) healed

Mean 14 months (2–67)

Low

Hull (2011) [2]

Rectovaginal fistula from obstetrical or cryptoglandular origin (1997–2009)

Rectal advancement flap

37

19 (54 %) with stoma

23 (62 %) healed

Median 39 months (13–70)

Low

Ellis (2008) [3]

Rectovaginal fistula (2000–2006)

Mucosal advancement flap (MAF), anodermal advancement flap (AAF), bioprosthetic interposition mesh repair with or without plug

29 MAF, 15 AAF, 27 bioprosthetic mesh interposition, 7 mesh plus plug

No

Healed:

MAF – 18 (62 %)

AAF – 11 (73 %)

Bio mesh – 22 (81 %)

Plug – 6 (86 %)

Mean 11 months (3–26)

Low

Gottgens, (2014) [4]

Recurrent rectovaginal or pouch-vaginal fistula (2009–2012)

Transperineal or transvaginal repair with collagen matrix biomesh

12 (10 transperineal repair, 2 transvaginal)

8 with stoma, 4 without

8 (67 %) healed

1 (8 %) healed after subsequent rectus abdominal transposition

3 (25 %) unhealed or recurrent

Median 22 months (2–45)

Low

Schwander (2009) [5]

Fistula in lower 2/3 of rectovaginal septum (2007–2008)

Surgisis mesh

21 (18 recurrent, 3 initial)

8 (38 %) with stoma

15 (71 %) healed

4 (19 %) healed after subsequent repair

2 (10 %) unhealed or recurrent fistula.

4 (19 %) minor postoperative complications

Mean 12 months (3–18)

Low

Schouten (2009) [6]

Low rectovaginal fistula from obstetrical, iatrogenic or cryptoglandular origin (2006–2009)

Rectal sleeve advancement

8

2 with stoma

5 (63 %) healed.

Median 12 months (3–17)

Low

Lamazza (2015) [7]

Rectovaginal fistula after XRT and anterior resection for rectal cancer (not available)

Endoscopic placement of self-expandable metal stent

15 (11 initial, 4 recurrent)

Yes, for recurrent fistula

12 (80 %) healed

1 (7 %) didn’t tolerate stent

Mean 22 months (4–39)

Low

Pitel (2011) [8]

Low rectovaginal fistula (2000–2010)

Martius advancement flap

20 (5 initial, 14 with prior rectal advancement flap, 1 prior Martius flap)

14 with stoma, 6 without

13 (65 %) healed

3 (15 %) minor wound complications.

Median 29 months (2–210)

Low

Songne (2006) [9]

Rectovaginal fistula (1994–2004)

Martius advancement flap

14 (10 initial, 4 recurrent)

Yes

13 (93 %) healed

1 (7 %) healed with subsequent repair

Mean 40 months (8–120)

Low

McNevin (2007) [10]

Rectovaginal fistula (2002–2006)

Martius advancement flap

16

6 with, 10 without

15 (94 %) healed

1 (6 %) recurrent

Mean 75 weeks (24–190)

Low

Cui (2009) [11]

Rectovaginal fistula (2003–2007)

Martius advancement flap

9 (3 initial, 6 recurrent)

Yes, for recurrent fistulas

100 % healed

Median 14 months (6–48)

Low

Troja (2013) [12]

Recurrent rectovaginal, pouch-vaginal or anovaginal fistula after primary closure (2004–2010)

Graciloplasty

10 (5 rectovaginal, 4 pouch-vaginal, 1 anovaginal)

Yes

6 (60 %) healed

1 (10 %) perineal wound defect

1 (10 %) hematoma

Median 50 months (20–63)

Low

Nassar (2011) [13]

Iatrogenic rectovaginal fistula (2002–2009)

Graciloplasty

11

Yes

11 (100 %) healed

4 (36 %) minor postoperative complications

Mean 35 months (12–67)

Low

Lefevre (2009) [14]

Recurrent rectovaginal fistula (2003–2006)

Graciloplasty

8

Yes

6 (75 %) healed

1 (13 %) healed after subsequent repair

1 (13 %) recurrence

Median 28 months (4–55)

Low

Ulrich (2009) [15]

Recurrent rectovaginal fistula (2003–2008)

Graciloplasty

9

Yes

7 (78 %) healed

Mean 28 month (3–52)

Low

Zmora (2006) [16]

Rectovaginal and pouchvaginal fistula w/history of prior repair or pelvic irradiation (1999–2005)

Graciloplasty

6

4 with, 2 without

5 (83 %) healed

1 (17 %) recurrence

1 (17 %) perineal wound infection

Median 26 months (9–74)

Low

Wexner (2008) [17]

Rectovaginal and pouchvaginal fistula (1995–2007)

Graciloplasty

17 (4 initial, 13 recurrent)

Yes

7 (41 %) healed

2 (12 %) healed after repeat repair

8 (47 %) unhealed

8 (47 %) minor wound complications

Not reported

Low

Schloericke (2011) [18]

Low or mid-rectovaginal fistula (2000–2010)

Transabdominal/transperineal omental flap

9

Yes (except 1)

8 (89 %) healed

1 (11 %) healed after subsequent repair

2 (22 %) with minor complications

Median 22 months

Low

van der Hagen (2011) [19]

Rectovaginal fistula between middle third of rectum and posterior vaginal fornix (2006–2009)

Laparoscopic excision and omentoplasty

40

2 (5 %) underwent stoma because omentoplasty not feasible

38 (95 %) healed

1 (3 %) necrotic omentum requiring reoperation

1 (3 %) abscess requiring drainage

Median 28 months (10–35)

Low

El-Gazzaz (2009) [20]

Crohn’s-related rectovaginal fistula (1997–2007)

Multiple

65

39 with stoma (60 %)

30 (46 %) healed

Median 45 months (13–79)

Low

Ruffolo (2008) [21]

Crohn’s-related rectovaginal fistula (1993–2006)

Multiple

52

Some with stoma (number not given)

29 (56 %) healed

13 (25 %) healed after subsequent repair(s)

Median 109 months (24–180)

Low

Löffler (2009) [22]

Crohn’s-related rectovaginal fistula (1991–2001)

Multiple

45

No

24 (53 %) healed with initial or subsequent repair

Median 48 months

Low