Symbolic illustration of rectovaginal fistula repair with a Martius graft.

Beyond Repair: A Novel Technique for Rectovaginal Fistula Treatment

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"Discover how a modified Martius graft procedure offers new hope for women suffering from rectovaginal fistulas after cancer treatment."

Rectovaginal fistulas (RVFs) are an unfortunate and often distressing complication that can arise following rectal cancer resection. These abnormal connections between the rectum and vagina can lead to a host of uncomfortable symptoms, significantly impacting a woman's quality of life. While various surgical techniques exist to address RVFs, finding a consistently effective and safe solution remains a challenge.

Traditional approaches to RVF repair can be complex and may involve extensive surgery with varying degrees of success. Recognizing the need for simpler, more reliable methods, surgeons are constantly exploring innovative techniques to improve patient outcomes. One such advancement involves a modified Martius graft procedure, offering a promising alternative for RVF repair.

This article delves into the details of this novel technique, highlighting its potential benefits and how it draws inspiration from the LIFT (ligation of the intersphincteric fistula tract) procedure. We will explore the surgical steps, patient outcomes, and the overall impact this approach may have on women seeking relief from rectovaginal fistulas.

The Modified Martius Graft: A Step-by-Step Approach to RVF Repair

Symbolic illustration of rectovaginal fistula repair with a Martius graft.

The modified Martius graft technique builds upon the principles of the LIFT procedure, which is commonly used to treat anal fistulas. The key steps involve:

Identifying and ligating the fistulous tract: The surgeon carefully locates the abnormal connection between the rectum and vagina and surgically closes it off.

Posterior interposition of a modified Martius graft: A flap of fatty tissue, known as a Martius graft (or "fat pad"), is harvested from the labia majora. This graft is then carefully positioned between the rectum and vagina to reinforce the closure and promote healing.
Reinforcing the closure: The interposition of the Martius graft provides additional support and helps to prevent recurrence of the fistula.

In a recent case study, a 63-year-old woman who developed an RVF after low anterior resection for rectal cancer underwent this modified Martius graft procedure. Following the initial cancer surgery, she experienced perineal sepsis and the distressing passage of gas and stool from the vagina, leading to a diagnosis of RVF. A temporary ileostomy was created to divert stool and allow the area to heal. Three months later, the modified Martius graft procedure was performed via a perineal approach. The outcome was reported as satisfactory, and the ileostomy was subsequently closed. Encouragingly, there was no recurrence of the fistula after 2.5 years of follow-up.

A Promising Solution for a Challenging Condition

While further research is always needed, the modified Martius graft technique appears to be a safe, simple, and effective approach for repairing rectovaginal fistulas, especially in cases arising after rectal cancer surgery. This innovative procedure offers hope for women seeking relief from this debilitating condition and highlights the ongoing advancements in surgical techniques aimed at improving patient outcomes and quality of life.

About this Article -

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Everything You Need To Know

What exactly is a rectovaginal fistula, and why is it a concern?

A rectovaginal fistula (RVF) is an abnormal connection that forms between the rectum and the vagina. It's a significant concern because it can lead to distressing symptoms such as the passage of gas and stool from the vagina, causing significant discomfort and impacting a woman's quality of life. This condition often arises as a complication following rectal cancer resection, which makes finding effective treatment options crucial.

How does the modified Martius graft procedure work in treating rectovaginal fistulas?

The modified Martius graft procedure addresses RVFs by building upon the principles of the LIFT procedure. The process involves a few key steps: first, the surgeon identifies and ligates the fistulous tract, essentially closing off the abnormal connection. Next, a Martius graft, which is a flap of fatty tissue harvested from the labia majora, is positioned between the rectum and vagina. This graft reinforces the closure and promotes healing. This interposition of the Martius graft provides additional support and reduces the chance of the fistula recurring.

What is the role of the Martius graft in the modified procedure?

In the modified Martius graft procedure, the Martius graft plays a critical role. It is a flap of fatty tissue, sourced from the labia majora, that's carefully positioned between the rectum and vagina. This graft is used to reinforce the closure of the fistula and promote healing. The interposition of the Martius graft provides additional support, helping to prevent the recurrence of the RVF and offering a more durable repair compared to some traditional methods.

How does the modified Martius graft procedure compare to other treatments for rectovaginal fistulas?

Traditional treatments for rectovaginal fistulas can be complex and might have varying degrees of success. The modified Martius graft procedure distinguishes itself by offering a potentially simpler and more reliable approach. It draws inspiration from the LIFT procedure, known for treating anal fistulas, and involves the use of a Martius graft to reinforce the repair. This method aims to improve outcomes and quality of life for women suffering from RVFs, especially those that occur after rectal cancer surgery, where effective solutions are especially needed.

What outcomes have been observed following the modified Martius graft procedure, and what does this mean for patients?

The case study of a 63-year-old woman highlights the promising outcomes. After undergoing the modified Martius graft procedure, she experienced satisfactory results, with no recurrence of the fistula observed after 2.5 years of follow-up. This outcome suggests that the technique is a safe and effective approach for repairing RVFs, particularly those occurring after rectal cancer surgery. It offers hope for women seeking relief from this debilitating condition by improving their quality of life and reducing the distressing symptoms associated with RVFs.