How do you approach patients with squamous cell carcinoma of anal canal with ano-vaginal fistula?

Try diversion colostomy, treat and see if it heals

Diverting colostomy and chemoradiation

Thanks that is what we are planning,hope fistula heal later or might need repair, I will treat in supine, no vaginal cylinder during therapy to avoid trauma to fistula site.

I would strongly consider diversion of the fecal stream, either a loop ileostomy or a diverting colostomy with mucus fistula. That would lessen the risks of infection while the patient is undergoing definitive radiation and chemotherapy.

I definitely would recommend against proceeding directly to A...