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

Abstract

Introduction Transvaginal mesh surgery can cause mesh complications including rare rectovaginal fistula. We report a case of a rectovaginal fistula treated transvaginally without colostomy. Case presentation A 57‐year‐old female was referred to us due to post‐hysterectomy prolapse and had transvaginal mesh surgery. She underwent transvaginal hysterectomy because of uterine prolapse at age 33 and had taken steroids to treat pemphigus. Two years later, she developed vaginal bleeding and discharge. Transvaginal mesh removal was planned to treat vaginal mesh exposure, but immediately before the operation digital rectal examination revealed rectovaginal fistula. Mesh removal and fistula closure were performed transvaginally without colostomy. Three years of follow‐up showed no recurrence of mesh exposure, fistula, or prolapse. Conclusion Rectovaginal fistula following mesh surgery may be treated transvaginally without colostomy if infection is minimal. To evaluate mesh exposure on the posterior vaginal wall, rectal examination should be done along with vaginal examination.

Urogenital Fistula Patients Profile at a Tertiary Hospital in Surabaya, Indonesia from 2015 to 2021

“…The repair approach should be decided on a patient-bypatient basis. Consultation to gastrointestinal surgeons can be done if necessary (Matsuyama et al 2022). Meanwhile, currently, the transvesical approach is rarely used, and the indication for a transabdominal approach is for complex fistulas, which require the interposition of a tissue flap between the bladder and vagina (Hadzi-Djokie et al 2015, Stamatakos et al 2014.…”