This topic is about finding the right colorectal surgeon for someone in northwest Oregon who needs a rectovaginal fistula repair and a colostomy reversal. The person has been living with a colostomy for six months, which was initially meant to be temporary. Here are some key points and advice to consider:

- The person is dealing with several complicating factors, including a rectovaginal fistula, extensive pelvic scar tissue, an ostomy hernia, a large kidney stone, IBS, and diverticulosis. These factors make the surgical process more complex.

- They have received different surgical opinions:
1. An experienced colorectal surgeon suggests one abdominal operation to repair the fistula and reverse the colostomy, followed by a temporary diverting ileostomy for about eight weeks.
2. A gynecologist specializing in fistulas recommends a vaginal repair first, allowing it to heal before performing a separate colostomy takedown.
3. Another fistula specialist was indecisive and referred them for another opinion.

- The person is trying to decide how many consultations are enough and which approach minimizes the risk of ending up with a permanent ileostomy.

- They are looking for a top-tier colorectal surgeon in northwest Oregon.

- There is a fear of having another stoma, especially if it becomes permanent, and concerns that dense adhesions and diverticulosis could complicate the procedures.

- The person has scheduled kidney stone surgery first and will proceed with bowel surgery afterward. They have booked surgery at OHSU in Portland with a team of 2-3 surgeons for a 6- to 8-hour abdominal reconstruction.

Here are some pieces of advice and insights:

- Consult widely, but focus on true colorectal specialists. Ask each surgeon about their experience with these procedures, their success rates, and potential worst-case outcomes. Write down questions and insist on full risk disclosure without rushing the decision.

- Consider a combined colorectal-GYN surgical team, as multiple members can improve outcomes, especially when the fistula is close to the anal sphincter and pelvic organs.

- A one-stage repair with a temporary diverting ileostomy is often preferred for low rectovaginal fistulas, as diverting the fecal stream gives the repair its best chance to heal.

- Explore less-invasive options first, such as the Cook Biotech Biodesign Anal Fistula Plug, which is low risk and might eliminate the need for major surgery if successful.

- Seek second or more opinions from:
- Oregon Health & Science University (Portland) colorectal service.
- Dr. Remzey at the Cleveland Clinic, a high-volume fistula and reconstruction surgeon.
- World-renowned colorectal surgeons in San Diego, if insurance and travel allow.

- On a psychological note, previous surgical experiences can make trust difficult. Take the time needed to regain confidence before committing to surgery.