Rectovaginal fistula: Anterior levatorplasty with simultaneous sphincter reconstruction

The procedure begins with the insertion of the anal speculum and the probing of the rectovaginal fistula, which in the film example appears as a connection between the rectum and the lower third of the vaginal canal. To facilitate dissection, physiological NaCl solution is initially injected percutaneously using the so-called infiltration technique. Then, the slightly curved access over the perineum is made using an electrosurgical needle. After transecting the subcutaneous tissue, the anal retractor is inserted.

Dissection of the rectovaginal space using an electronic needle with subtle hemostasis. The preparation must extend beyond the fistula tract and allow for the secure identification of the levators lateral to the vagina and anorectum. The goal is to approximate the levator muscles as a barrier between the posterior vaginal wall and the anterior rectal wall as described in the following steps.