Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature.The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found.Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.Rectovaginal fistula (RVF) is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, although congenital abnormalities do exist. Acquired RVFs can occur due to various causes. The most common acquired cause is obstetric. RVFs can be classified into low and high variety. Although perineal approach is the preferred one for low variety, high fistulas are best approached transabdominally. High RVFs are most commonly approached by a conventional open technique. We describe laparoscopic technique of repairing a case of high RVF. So far there is only one report in literature mentioning primary closure of RVF by laparoscopic technique [1].We are describing our technique of laparoscopic management of high RVF in a 56 year old lady who developed RVF following laparoscopic assisted vaginal hysterectomy. She was admitted with complaints of passing flatus and feces per vagina for 11 months. Laparoscopic assisted vaginal hysterectomy with bilateral salphingo-oopherectomy was done 18 months back for leiomyoma uterus. She started passing flatus and feces per vagina 4 weeks after the surgery. Clinically the patient was obese (BMI-32). Patient had no features of sphincter disturbance. Per vaginal examination revealed a small area of induration high in the vault. The vault was healthy. Routine blood investigations were normal. USG abdomen was normal. Instillation of methylene blue into the rectum with a vaginal tampon co