Rectovaginal fistula

[Joannerogers]

Hello everyone. I would like to know if anyone has any experience with a rectovaginal fistula. I unfortunately have one. I have already had one surgery to fix it but it was unsuccessful. Doc wants to wait six months before he tries it again. That means at least 6 more months with my illeostomy. Then he's acting like its no big deal...says I can just give you a permanent colostomy!

That's the last thing I want! He's also talking about a possible j pouch since he thinks he might have to use more of my colon to fix the fistula which I'm not sure I want either, and he's talking about doing them both at the same time. Is that a good idea since the first surgery failed. I'm not sure if a leaking colon is safe. Any ideas I can run by him at my next appointment?

[susan f]

Hi Joannerogers,

I had a vaginal/j-pouch fistula when I had my colon removed for IBD. I had several surgeries to try and repair this, none were successful because of the underlying inflammation and disease in my j-pouch. Every time the IBD would flare up the fistula would too.

Do you have IBD or any other issues that caused the fistula? Or was it the result of childbirth or something else? That could be a factor in the success of the repair.

I would suggest you get a second opinion on this, as I haven't ever heard of using a colon to repair a vaginal fistula before. The surgeries I am familiar with use a muscle from your leg, or moving the fascia around to separate the rectum and vagina.

[Joannerogers]

I had rectosigmoid cancer. After the surgery to remove the cancer I developed a mrsa infection and they say that's what caused the fistula. So they went back in and did the illeostomy so I wouldn't leak stool in my abdomen. Several months later they attempted the fistula repair that was unsuccessful. The doc says now he can use cow or pig skin I guess as a sort of patch. But his explanation of using the colon is that he can pull the colon over the hole to cover it and stitch it into place. But that will take some more of what colon I have left which might make a difference in whether or not I would need a j pouch. I think if I can keep the colon I have left I might not have as much trouble readjusting to normal bowel functions. I don't know how much colon was taken. I asked but he just held his arms out and said this much. I didn't get an amount like 1 foot or 2 feet. I'll ask when I see him for my next surgery consult. I would really like to keep my rectum if at all possible.

[susan f]

Crossing my fingers for you - R/V fistulas are tricky.

[Sharmac]

Hi,

I had/have a r/v fistula. Probably due to diverticulitis. I had a colorectal surgeon do surgery to repair it on 1/12/17. I developed a post op infection which basically blew out the repair (a fascia patch as I understand it), thereby creating a large opening for stool to pass vaginally. This led to an unplanned colostomy to divert stool and allow area to heal. In a couple months I expect to have another repair of the fistula. A couple months after that heals I expect to have a reversal of the colostomy.

One of the hardest things about medical care is finding a good surgeon. Sounds like you might benefit from a second opinion since your doctor doesn't seem able to explain things to you very satisfactorily. We have to be our own advocates. I hope you can contact your insurance company and find someone else you can talk to.

[rmcknight923]

Hello,
I had a hysterectomy and reconstruction on January 13, 2017. I had complications and developed a retrovaginal fistular that was repaired on 1-24-17 but still has 1cm that has not healed. My surgeon has suggested a temporary ilieostomy to allow it to finish healing. I would love to hear anyone's thoughts on this recommendation. Thank you.

[Doubletrouble]

I am sorry to read so many women have to deal with this terrible diagnosis. I became aware of my own RV fistula July 2016. Mine caused by delayed radiation damage (rectal cancer). So far have had 2 unsuccessful repair surgeries. During first attempt colostomy was placed. Initially not too happy about because 2 months prior I had an ileostomy takedown which I was adjusting very well to. However the colostomy sure is better then the alternative of BM exiting where it should never ever exit, not to mention passing gas! So in my opinion, an ostomy is quite helpful while healing and/or treating a Fistula. An upcoming repair surgery is scheduled using thigh muscle, hopefully this one will work.

[rmcknight923]

I am sorry to read so many women have to deal with this terrible diagnosis. I became aware of my own RV fistula July 2016. Mine caused by delayed radiation damage (rectal cancer). So far have had 2 unsuccessful repair surgeries. During first attempt colostomy was placed. Initially not too happy about because 2 months prior I had an ileostomy takedown which I was adjusting very well to. However the colostomy sure is better then the alternative of BM exiting where it should never ever exit, not to mention passing gas! So in my opinion, an ostomy is quite helpful while healing and/or treating a Fistula. An upcoming repair surgery is scheduled using thigh muscle, hopefully this one will work.

I can't tell you how thankful I am for you responding Doubletrouble! It has taken this long for my post to be approved. I would love to hear more. Why does your surgeon think the repairs are not healing? What did he/she use the first two times to repair it? Do you know why he/she did a colostomy rather than another ileostomy? How does he/she determine it hasn't healed if you don't have stool exiting? What kind of diet were you on with the ileostomy? Any hints/tips for dealing with an ileostomy? Sorry for the avalanche of questions--but I'm desperate!

[Doubletrouble]

Rmcknight923, I'm glad the info was helpful! My first repair was made by removing the radiation damaged tissue, and using biological mesh. The fistula was quite large due to the severity of the damaged tissue. After the first repair I underwent 60 days of Hyperbaric Oxygen treatment (m-f) for 2 hrs. That treatment helped to heal the radiated tissue. 2nd repair also used biological mesh, the fistula was much smaller at that point, but still not fully healed. I had an MRI done 4 months after the first repair & that still should tract was there. An exam after 2nd repair indicates tract remains yet again. I am scheduled for 3 rd repair soon. I was given colostomy because I had previously had an ileostomy which was reversed 2 months prior to the fistula occuring. I had my ileostomy placed due to colon resection done in 2015. I had a great ostomy nurse , who had a wealth of information! I was given dietary guidelines which I did follow very closely. I was very conscious of all food I ate. I did avoid a lot of high fiber foods, and fresh fruits & veg. I ate canned veg & fruit cups along with bananas and pealed apples. On the up side I did lose some weight! Good luck with your procedure!

[rmcknight923]

Rmcknight923, I'm glad the info was helpful! My first repair was made by removing the radiation damaged tissue, and using biological mesh. The fistula was quite large due to the severity of the damaged tissue. After the first repair I underwent 60 days of Hyperbaric Oxygen treatment (m-f) for 2 hrs. That treatment helped to heal the radiated tissue. 2nd repair also used biological mesh, the fistula was much smaller at that point, but still not fully healed. I had an MRI done 4 months after the first repair & that still should tract was there. An exam after 2nd repair indicates tract remains yet again. I am scheduled for 3 rd repair soon. I was given colostomy because I had previously had an ileostomy which was reversed 2 months prior to the fistula occuring. I had my ileostomy placed due to colon resection done in 2015. I had a great ostomy nurse , who had a wealth of information! I was given dietary guidelines which I did follow very closely. I was very conscious of all food I ate. I did avoid a lot of high fiber foods, and fresh fruits & veg. I ate canned veg & fruit cups along with bananas and pealed apples. On the up side I did lose some weight! Good luck with your procedure!

Wow Doubletrouble! You have had journey that I'm afraid I would have buckled under. I am amazed at your courage and strength. Thank you so very much for the information!

[Capercrohnie]

I'm having a total proctocolectomy (in 2 surgeries) and a permanent ileostomy because of 3 RV from crohn's. They are nasty!

[rmcknight923]

I pray your surgeries go successfully. It sounds like you've been through enough.

[rmcknight923]

Do patients have retrovaginal fistulars that do heal? Or is it, once you have one you always have one?

[Joannerogers]

Hello everyone,
Good news for me! My second surgery to repair the rv fistula seems to have worked! The doc redid my original anastomisis moving it below the fistula and closed the fistula with stitches. He said I still had a small sinus tract there and wants to repeat the barium enema before my reversal surgery. This happens this Thursday so I'll try to update the curious. So it seems as though they can be repaired...I believe time to heal is the biggest asset.

[rmcknight923]

That's fantastic!!! Please do keep us updated!