Colostomy plays a pivotal role in the management of complex or recurrent rectovaginal fistulas (RVF) by diverting fecal flow away from the fistula site. This diversion reduces local contamination and inflammation, creating an optimal environment for healing and reducing the risk of repair breakdown. It is not routinely used as first-line treatment but reserved for cases where primary repair has failed or the fistula is large, complex, or associated with significant tissue damage. Thus, colostomy supports surgical success and symptom control in challenging RVF cases.

Reference: Sabiston Textbook of Surgery, Townsend CM, 21st Edition.