Figure 1: Algorithm for treatment of (recurrent) RVF
The first priority is sepsis control. Next the type of fistula, high or low should be determined and complicated and uncomplicated. In the case of a high fistula, an abdominal procedure should be performed. In the case of low fistula the course of therapy depends on the presence or absence of pelvic sepsis. If there is no severe pelvic sepsis, local procedures should be carried out. In the case of recurrence, gracilis interposition flap should be performed. (Modified from [25]).