Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review

Colorectal Dis. 2015 Feb;17(2):104-10. doi: 10.1111/codi.12791.


Background: Repair of rectovaginal fistula (RVF) is associated with high recurrence. For this reason gracilis muscle interposition is increasingly being used.

Aim: To evaluate the efficacy of this procedure for RVF repair.

Method/search strategy: A search of PubMed and Medline databases was performed in November 2013 using the text terms and MESH headings 'rectovaginal fistula/fistulation', and 'gracilis muscle', spanning 1980-2013. The search strategy was restricted to articles written in English with available abstracts. Sample size, aetiology of RVF, previous repair attempts, follow-up period, healing rates and complications were recorded and analysed.

Results: Seventeen studies involving 106 patients were analysed. The cause of RVF included inflammatory bowel disease (n = 37 [34.9%]: Crohn's disease [34], ulcerative colitis [3]), pelvic surgery (37 [34.9%]), obstetric injury (9 [8.5%]), malignancy (7 [6.6%]), trauma (5 [4.7%]), miscellaneous (idiopathic, endometriosis, radiation: 11 [10.4%]). Patients had undergone a median number of two previous unsuccessful repairs. At a median follow-up of 21 months, healing had occurred in 33-100% (median 100%) with the largest studies reporting rates between 60% and 90%. Thirteen studies did not report any complications, with the remainder reporting only minor morbidity.

Conclusion: Gracilis interposition appears to have a reasonable success rate for RVF repair with acceptable morbidity. It may be considered as one of the first-line treatment options for recurrent RVF.

Keywords: Rectovaginal fistula; anovaginal fistula; gracilis muscle interposition/transposition.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Middle Aged
  • Muscle, Skeletal / transplantation*
  • Plastic Surgery Procedures / methods*
  • Rectal Fistula / surgery*
  • Rectovaginal Fistula / surgery*
  • Recurrence
  • Treatment Outcome
  • Vaginal Fistula / surgery*
  • Young Adult