Clinical outcomes of transvaginal fistulectomy and internal orifice closure in rectovaginal fistulas secondary to stapled prolapsectomy: a monocentric case series

BACKGROUND: Rectovaginal fistula (RVF) is a rare but severe complication of stapled prolapsectomy (SP), resulting from inadvertent inclusion of the posterior vaginal wall within the stapler line. RVFs secondary to SP represent a distinct iatrogenic subtype, characterized by a short, low-lying fistulous tract and localized ischemic tissue damage. We evaluated the feasibility and outcomes of a transvaginal repair strategy consisting of inverse T-shaped colpotomy, transvaginal fistulectomy, closure of the rectal defect from the vaginal side, and layered reconstruction without fecal diversion in patients with early RVF after SP. METHODS: This monocentric, retrospective observational study included adult female patients treated for RVF secondary to SP between January 2023 and April 2025. All patients underwent transvaginal fistulectomy with internal orifice closure without protective stoma. Demographic data, fistula characteristics, operative details, postoperative outcomes, and healing at 6 and 12 months were analyzed. RESULTS: (range 20-25). Median time from SP to RVF repair was 18 days (range 15-30). Median operative time was 91 min (range 45-110). No intraoperative or postoperative complications occurred (Clavien-Dindo grade 0). At both 6- and 12-month follow-up, all patients demonstrated complete clinical healing, with no persistence, recurrence, or late complications. CONCLUSIONS: Transvaginal fistulectomy with internal orifice closure without fecal diversion could be a safe and effective surgical option for RVF secondary to SP. Given the limitations of this small retrospective single-cohort series, these findings should be considered preliminary. TRIAL REGISTRATION: Number CET 371-2025, date of registration 12/11/2025, retrospectively registered.