@lhstephenson I'm sorry to hear that your are not getting a convincing proposition for a solution to your recto-vaginal fistula.

Here is a bit more of my story. In Dec. 2022, I had a transanal resection of a big polyp. The biopsy revealed positive margins, hence a diagnostic of rectal cancer stage 0. Since the surgeon considered that she would not be able to do a new and effective resection given that it was a matter of margins, I had radiotherapy with oral chemo in Feb.-March 2023. By June of the same year, I started noting something and by August, my oncologist confirmed that I had a recto-vaginal fistula, due to the resection being quickly followed by a full radiotherapy protocol.

I spent the next three months looking for a solution I could feel confident about. My original surgeon said that a vaginal repair was not necessary, according to a gynecologist friend of hers, and that she could do a flap to close the fistula on the rectal side, with a temporary colostomy. However, the possibility of a new fistula forming was very high, over 60%, if my memory is correct. That was not a happy solution for me. I started investigating and I consulted two more surgeons. Both wanted to first see a new colonoscopy, which not only showed the fistula, but a new polyp. Both agreed that I should go for a radical surgery: the two-step Turnbull-Cutait pull through, which would garantee that my risk of a new fistula would be that of a normal person and also it would reduce my risk of the cancer returning. And a vaginal repair

So in Jan. 2024, the first surgery was to remove my rectum, sigmoid and mesorectum, and to pull a bit of my colon through the anus. After a week, that little bit was cut and I had a coloanal anastomosis. This allows one to avoid a temporary colostomy and avoid a J pouch. My surgeon was clear that this meant that I would suffer from LARS. He had trained for the surgery in Texas, not sure where.

Two years after the procedure, I'm happy with the results. It took a while for me to adapt to my new fisiology. My vagina shrunk a bit, was dry and the stitches started incommodating me, but all got resolved in due time. Now I can have sex as I did before, even if sometimes I need to interrrupt to go to the bathroom, because sometimes it makes things move in the colon, and sometimes I can't stand the pressure of some carresses or due to the position, on my colon or anus. But I have a very satisfactory sex life again.

As for LARS, it's been an adventure in learning to manage it, but in my case, it's mostly light.

In short, I believe the procedure was effective. I went for my second-year controls post the Turnbull-Cutait and everything is in order.