A recto-vaginal fistula is a serious but rare complication that can occur after gender-affirming surgery (vaginoplasty). It results in an abnormal connection between the rectum and the neovagina, leading to stool leakage through the vaginal canal — a distressing and medically significant condition.
How Does a Recto-Vaginal Fistula Happen?
- Initial Injury During Surgery
During the creation of the neovaginal canal, the rectum — which lies just behind the dissection field — may accidentally be injured. If the dissection goes too deep, it can cause a small perforation in the rectal wall. - Postoperative Breakdown
If the perforation is closed during surgery but fails to heal properly, leakage and infection may occur at the suture line. This can eventually lead to tissue damage, inflammation, and the formation of a fistula. - Tissue Erosion
Once inflammation spreads to the neovaginal wall, located next to the rectum, the tissue may gradually break down. This results in a permanent passage or tunnel between the two organs — known as a recto-vaginal fistula.
Signs and Symptoms
- Stool discharge from the neovagina
- Persistent foul odor or infection
- Pain or discomfort during vaginal dilation
- In some cases, symptoms are noticed only after gauze removal or during the recovery phase
Why Simple Repair Often Fails
Traditional surgical repair methods attempt to close the fistula directly. However, due to weakened, scarred, and non-elastic rectal tissue, these repairs are fragile and prone to breakdown — especially during vaginal dilation.
The Most Reliable Solution: Colon Vaginoplasty
At WIH International Hospital, Dr. Chettasak Tulayaphanich offers a more effective and durable solution: secondary colon vaginoplasty.
Benefits of This Technique for Fistula Repair:
- Thicker Colon Wall: Provides stronger support to reinforce the fistula repair area
- New Vaginal Canal: Replaces the old, inflamed skin canal — eliminating the source of chronic inflammation
- Improved Depth & Functionality: Colon tissue allows for deeper, lubricated, and more resilient neovagina
- Long-Term Success: Nearly 100% success rate in preventing fistula recurrence
Before reconstruction, all remaining skin inside the old canal must be excised to prevent further complications. The fistula site is closed securely, and the new canal is created using healthy colon tissue via laparoscopic technique — ensuring minimal scarring and faster recovery.
✅ Learn more about our advanced techniques:
👉 Secondary Colon Vaginoplasty for Treating Vaginal Narrowing or Stenosis
