This topic revolves around a person who has been living with a rectovaginal fistula for seven years and is now considering two surgical options. The choices are between attempting to repair the fistula with a temporary ileostomy or converting an existing loop colostomy into a permanent end colostomy. Here are some insights and advice shared by others who have faced similar decisions:

1. The first option involves trying to close the fistula vaginally and removing the affected part of the colon, then reconnecting the healthy ends. This has a low success rate of about 10% and would require:
- Creating a temporary ileostomy during the healing process, which the person has previously found challenging due to appliance leaks.
- A second surgery to reverse the ileostomy.
- A risk of impaired bowel function after reconnection, and if it fails, another operation to form a permanent colostomy.

2. The second option is to skip the fistula repair and instead remove the colon up to just above the rectum, converting the existing loop colostomy into a permanent end colostomy, which would require only one operation.

Additional considerations include:
- The person had hernia surgery six months ago with extensive scar-tissue removal and mesh placement, and now suspects another hernia.
- Either surgical route will involve removing the current mesh and a fourth mid-line abdominal incision in 8½ years.
- The person is seeking first-hand experiences and opinions on whether to attempt the low-success-rate repair or proceed directly to an end colostomy.

Advice and insights from others include:

- Decision-making:
- Many emphasize that the choice is deeply personal and should consider quality of life, surgical risks, and overall health.
- Writing a detailed pros-and-cons list can help clarify priorities and potential regrets.

- Experiences with reversals and permanency:
- One person declined reversal due to the risks involved after a previous near-death experience during surgery.
- Another chose reversal, enjoyed six good years, and later needed a permanent ileostomy, feeling the temporary success was worth it.
- A third person had two colectomies for diverticulitis; the fistula was repaired, but the "temporary" ileostomy has lasted eight months.

- Appliance and stoma management:
- Several people confirm that ileostomies can leak and be harder to manage than colostomies, with a learning curve and potential fitting challenges.

- Wound-care tips:
- For closed perineal wounds after rectum removal, daily application of Sudocrem followed by Vaseline has helped keep the area comfortable and sealed.
- Another person had an open abdominal wound packed and treated with a wound-vac, noting that this technique may result in wider scars.
- Some experienced painless removal of self-dissolving sutures, while others found staple removal painful.

- Information resources:
- A YouTube channel called "LetsTalkIBD" by Maggie, a Crohn’s patient with a fistula and now a permanent ileostomy, offers useful first-hand accounts.