Table 2 INDICATIONS OF SURGICAL TECHNIQUES

AGE:

   • Young women: less aggressive procedures with safeguard of vaginal integrity, when it is possible

   • Elderly women: interventions for the drastic resolution of the problem with abdominoperineal approach;

ETIOLOGY:

   • Post operative, traumatic and infectious RVFs

- MAF;

- recidivists: bowel resection with trans-anal anastomosis acc.to Babcock (or to Parks) + epiploon interposition;

   • Post-radiotherapy RVFs

- colostomy + waiting for 3-6 months: if it's necessary, bowel resection with coloanal anastomosis or pull-throuh resection acc. To Babcock-Bacon;

- in absence of bleeding: bulbocavernosus muscle interposition am to Martius:

- in case of vulva sclerosis: inside rectum muscle interposition;

- when other attembt to repair fail -> definitive colostomy.

   • IBD RVFs

- drainage qf perinal abscesses o trans-.sphinteric loop;

- if it's necessary: colostomy for 3-6 months;

- 3 months of antimetabolites therapy:

- in more serious cases: bowel resections.

   • Tumoral RVFs

low anterior resection of the rectum or amputation of Miles + back colpectomv;

LOCALIZATION:

   • High RVFs requires interventions with combined approach;

   • Low RVFs requires a perineal approach

   • Mid RVFs require an approach depending on etiology and eventually associated lesions