TEMS: an alternative method for the repair of benign recto‐vaginal fistulae

Indications  The repair of high recto‐vaginal fistula can be challenging since access may be limited via the endo‐anal approach yet the alternative trans‐abdominal route carries significant morbidity. We report the use of TEMS to repair a recto‐vaginal fistula following anterior resection and pelvic radiotherapy. Method  The patient was placed prone and a 25cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. Comparison with other techniques  TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo‐anal or trans‐vaginal techniques. The morbidity is lower than the trans‐abdominal route. Comments  TEMS is a useful technique for the repair of benign recto‐vaginal fistula and has distinct advantages over conventional techniques.