Overall success rates reported in the literature for the interposition of a Martius flap as an adjunct procedure in the surgical management of RVF are 65–100% [1] The primary objective of the study was to compare the mean success rate, while the secondary objective was to find out the perioperative complication rate and recurrence in the patients of Rectovaginal fistula repair (RVF)with or without Martius flap.

It was a retrospective observational study of adult women who were operated for rectovaginal fistula (RVF) in our institute from January 2023 to January 2025(two years). A total of 56 women who had undergone surgery were enrolled, out of them in 15 cases Martius flap was used to repair the RVF (who had a history of at least one failed surgery). In the rest of the 41 patients,15 patients were randomly chosen as a control group, comparable in age and parity for comparison of the surgical outcome.  RVF healing was defined as the absence of vaginal discharge during 6 months after surgery. The details of the operated women were taken from the medical record section and also questions were asked in follow-up visits after proper informed consent and anonymization of the data. To avoid heterogeneity of the study all cases of Obstetrics fistula were taken, post-radiation, gynae fistulas, and more than 4 cm complicated were not taken. Quantitative data were reported as means ± standard deviation (range) and compared using the student t-test or the Mann–Whitney U-test. Qualitative data were analyzed using the chi-square test or Fisher’s exact test. P-values < 0.05 were considered significant.

Out of 56 patients, 15 patients were included in each group, Group A was RVF repair with Martius flap and Group B was repair without Martius flap. The mean age in group A was 34.35±8.22 and in group B was 32.15±7.61 years, almost comparable in both groups (p-value is 0.30). Blood loss, mean operating time, hospital stay, and the requirement of analgesics were almost similar between groups A and B. The success rate was 93.33% (one case of incontinence out of 15) in transvaginal repair with Martius flap versus 86.66% (2 cases of incontinence out of 15) in transvaginal repair with no flap (p=0.275).[2] The median follow-up of cases was around 14 months. The infection rate within one month of operation was higher in the Martius flap group about 46.66% (7 in 15 patients) versus 33.33% (5/15) in RVF repair without the Martius flap group,

There is no consensus in the literature on the best technique for RVF repair including the use of interposition graft or flap. In our study, we found an almost similar success rate of repair in both groups with a p-value of 0.275. However, the rate of infection was higher in the Martius flap group, similar findings were present in the study by Vishwajeet Singh et al [2]. Perioperative complications and recovery course were almost similar in both groups except for slightly increased operating time in the Martius flap group as an extra step was added.

The success rates are similar in lower RVF repairs (fistula size less than 4 cm, history of up to one failed surgery) irrespective of the use of Martius flaps. However, overall morbidities following repair with the Martius flap are higher when compared with repair without the interposition flap. However, more randomized trials and bigger sample sizes are required to confirm the findings.

.M. Reichert, T. Schwandner, A. Hecker, et al., Surgical approach for repair of rectovaginal fistula by modified Martius flap, Geburtshilfe Frauenheilkd. 74 (10) (2014) 923–927, https://doi.org/10.1055/s-0034-1383149
Vishwajeet Singh, Seema Mehrotra, et al. Prospective randomized comparison of repairing vesicovaginal fistula with or without the interposition flap: Result from a tertiary care Institute in Northern India. Turk J Urol 2019; 45(5): 377-83 • DOI: 10.5152/tud.2019.85233
J. Fu, Z. Liang, Y. Zhu, L. Cui, W. Chen, Surgical repair of rectovaginal fistulas: predictors of fistula closure, Int. Urogynecol. J. 30 (10) (2019) 1659–1665, https:// doi.org/10.1007/s00192-019-04082-w.