Transanal advancement of the anterior rectal wall for vaginal fistulas involving the lower rectum.

Experience from a personal series of nine patients with anovaginal or low rectovaginal fistula, operated upon by what is known as the Noble-Elting-Laird technique, is presented and added to the literature concerning the subject. Extensive preoperative mechanical bowel preparation including antibiotics was unnecessary as was a diverting colostomy. There were no operative deaths. Fistula did not recur in any of the nine patients followed six months, nor in any of eight of the nine patients followed over a period of two to 20 years. On comparing patients with anovaginal and rectovaginal fistula treated by transanal advancement of the anterior rectal wall with those patients treated by local layer closure, vaginally or anally, transanal advancement of the anterior rectal wall seems to be the better choice, particularly for the patient with a recurrent fistula. The data support the thesis that, since the anorectum is the primary source of such vaginal fistulas, the condition is best approached and treated accordingly.