Rectovaginal fistula or perineal and anal sphincter disruption, or both, after vaginal delivery

The management of 52 patients with rectovaginal fistula or perineal and anal sphincter disruption, or both, after vaginal delivery is presented. Adequate physical intestinal preparation and postoperative diet and intestinal care are stressed. Preservation of perineal integrity is suggested whenever possible. Closure in anatomic layers is the technique of choice and sphincterotomy is advised in all instances of anal sphincter anastomosis. The technique for repair of an extensive cloacalike lesion is described in detail, as are three unusual complications of operation. Satisfactory anatomic and functional results were obtained in 100 per cent.