Successful repair of a rectovaginal fistula caused by a tension-free vaginal mesh (TVM): a case report

Abstract

Abstract:Rectovaginal fistula caused by a tension-free vaginal mesh (TVM) is a rare condition. Moreover, a rectovaginal fistula is a challenging issue to address for surgeons regardless of causes. Due to a low rate of occurrence, treatment modality for a rectovaginal fistula caused by a TVM has previously received little attention. A successful surgery using several key techniques to address a rectovaginal fistula caused by a TVM is herein reported. A 78-year-old woman who underwent a TVM for a rectocele three months ago was referred to our hospital with a two-month history of anal bleeding. Mesh protruding into both the vagina and the rectum was confirmed. The patient was operated on under diagnosis of a rectovaginal fistula caused by TVM. TVM was removed by transvaginal dissection of the rectovaginal septum with division of both anterior and posterior arms of the TVM. Layer-to-layer sutures of rectal and vaginal walls were crossly performed with a drain placed in the rectovaginal septum after saline irrigation followed by a covering sigmoid colostomy. The wound healed without infection after surgery, and a water-soluble contrast enema demonstrated the healing of the rectovaginal fistula two months after surgery. No recurrent fistula was confirmed 15 months after stoma closure.

Transvaginal repair of a rectovaginal fistula caused by transvaginal mesh prolapse surgery

“…In general, 85% of RVF are caused by obstetric trauma, and 5–7% of RVF is attributed to pelvic and rectal surgery while inflammatory bowel disease, malignancy, and radiotherapy cover most of the remaining etiologies 12 . With the spread of mesh prolapse surgery, postoperative RVF cases have been reported over the last two decades 4–9 …”

“…In Japan, Koide et al . reported an RVF which was found due to hematochezia one month following TVM 9 . RVF symptoms include hematochezia, the passage of air and stool from the vagina, vaginal bleeding and discharge, and dyspareunia.…”

“…12 With the spread of mesh prolapse surgery, postoperative RVF cases have been reported over the last two decades. [4][5][6][7][8][9] Mesh complications are more commonly reported after TVM, but abdominal sacrocolpopexy, LSC, and RASC are also causes. Regarding TVM, vaginal mesh exposure is the most frequent complication and its reported prevalence is 2.7 -17% 3 though the prevalence is low in Japan (0.7-3.2%) likely due to surgical education.…”

“…3 Conversely, RVF is one of the least frequent, and management methods are not well established. [4][5][6][7][8][9] We report a case of RVF following TVM which was successfully repaired by a transvaginal approach without colostomy. underwent transvaginal hysterectomy and colporrhaphy due to uterine prolapse.…”

Outcomes of Transvaginal Anterior Levatorplasty with Posterior Colporrhaphy for Symptomatic Rectocele

“…It might be due to the lack of strength of the repaired rectovaginal septum for supporting long-term constant defecation. Recent reports revealed that mesh erosion, pain, infection, bleeding, pain during intercourse, fistula formation, and so on had occurred after repairs using mesh [14][15][16]. Transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele to reinforce the rectovaginal septum without mesh had favorable short-term outcomes in a limited number of cases [2].…”