Impact of Fecal Diversion on Outcomes Following Martius Flap Repair for Rectovaginal Fistula.

INTRODUCTION AND HYPOTHESIS: Rectovaginal fistula (RVF) repair remains surgically demanding, and whether a diverting stoma genuinely improves outcomes after Martius flap interposition is still unclear. Although diversion is traditionally advocated to minimize contamination and enhance healing, emerging evidence challenges its routine use. This study evaluated the impact of stoma diversion on recurrence, postoperative complications, and quality-of-life outcomes following Martius flap repair. METHODS: This retrospective two-center cohort included women undergoing Martius flap repair for RVF between 2015 and 2025. Patients were grouped on the basis of whether a diverting stoma was present or created at surgery. Demographics, fistula characteristics, complications, recurrence, and Cleveland Global Quality of Life (CGQL) scores were compared. RESULTS: Seventeen patients were included (ten with diversion, seven without). Baseline characteristics were similar between groups. Recurrence was markedly lower in the diversion group (10.0%) compared with the non-diversion group (42.9%). The overall recurrence rate was 23.5%. Reoperation was required in 42.9% of the non-diversion patients but in none of the diversion patients. CGQL scores were comparable between groups. CONCLUSIONS: The rate of unplanned fistula-related reoperation was lower in the stoma group following Martius flap repair for rectovaginal fistula. Recurrence also showed a trend toward a lower rate in the stoma group, although the difference was not statistically significant. Larger multicenter prospective studies are needed to confirm these findings and determine which patients may benefit most from diversion.