Purpose: Stool coming out from vagina could be stressful to the women, especially following delivery. Some women may also prone to anal incontinence because of birth injury. Appropriate management of the problem is important for patient’s quality of life. This is a retrospective analysis of a single surgeon’s experience of repairing rectovaginal fistula caused by birth trauma, stressing the importance of perineal body reconstruction in a tertiary referring medical center.

Materials and Methods: This is a retrospective analysis from March 1983 to June 2024, 67 patients who had direct repair of rectovaginal fistula by a single surgeon. Excluded were patients who had malignancy as the cause of anal incontinence. Patients who had bowel resection as the treatment of choice for incontinence were also excluded. 62 of them had birth trauma as the cause of fistula. Ages ranged from 21 to 65 years old, with an average of 35.8 years old for those who had fistula caused by birth trauma. Ages ranged from 13-75 years old with an average of 40.8 years old for those who had fistula not caused by birth trauma. All of the patients complained to some degree of anal incontinence prior to the repair of rectovaginal fistula.

Results: Two patients in the direct repair of rectovaginal fistula group had recurrences of fistula which necessitate a second repair. No patients in the series had intentional creation of a stoma by the surgeon. However, two patients had a stoma created before being seen by the surgeon. The patients in this series showed high rate of satisfaction of anal continence following surgical treatment.

Conclusions: Reconstruction of perineal body is important because associated anal sphincter defect by birth trauma or previous failure of repair frequently present as the cause of incontinence.