Rectovaginal fistula surgery with horizontal mattress and running suture after unsuccessful first repair: a report of two cases.

Rectovaginal fistula (RVF) repair after failed primary repair is uncommon. Patients with RVF experience physiological and sexual dysfunction with a significantly high risk of intravaginal infection and sepsis. There are many surgical procedures available for RVF repair. We performed an improvised transvaginal repair technique. Methods: We report two cases of recurring RVF after failed primary repair. Patient 1 developed RVF because of a failed vaginoplasty due to cosmetic reasons, while patient 2 developed RVF because of a fourth-degree perineal rupture repair post-delivery. We used a combination of horizontal mattress and running suture with the addition of diverting colostomy. Both surgeries went successfully and there were no complications. Outcomes: RVF repair using a combination of horizontal mattress and running suture went successfully and there were no complications. Both patients were able to be discharged after a short stay. Long-term evaluation was done by physical and supporting examinations for 2-3 months. Both patients showed excellent wound healing and physiological function. Conclusions: The combination of a transvaginal horizontal mattress and running suture in the posterior to anterior fashion with diverting colostomy is a safe and effective procedure for recurring RVF repair.