Two-stage surgical repair of anovaginal fistula following Bartholin abscess treatment

Anovaginal fistulas (AVFs) are aberrant pathways located between the anal canal and the vagina. They frequently occur in resource-limited countries as a result of pressure necrosis on the rectovaginal septum caused by prolonged or obstructed labor. In addition, it is observed as a result of improper repair of third- and fourth-degree anal sphincter injuries after birth, injuries that are not noticed during delivery, and infections that develop in the episiotomy area. Delayed treatment of perirectal, perianal, and Bartholin abscess or cyst, and surgical interventions on the posterior vaginal wall, rectum, and perineum, are all contributing factors. The aim of this study was to describe the surgical treatment method applied to a patient with an anovaginal fistula, who was admitted with a complaint of gas and stool passage through the vagina for 3 months with the drainage of a Bartholin abscess in its etiology, which affects the anal sphincter complex trans-sphincterically and which was detected to be open to the distal dentate line on proctological examination. The development of an AVF has a considerable negative impact on an individual’s quality of life. It is a difficult condition both individually and socially. Achieving successful results requires effective evaluation and examination.

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1. Zheng Y, Zhang N, Lu W, Zhang L, Gu S, Zhang Y, et al. Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter? J Int Med Res 2018;46:852–64.
2. Andreani SM, Dang HH, Grondona P, Khan AZ, Edwards DP. Rectovaginal fistula in Crohn’s disease. Dis Colon Rectum 2007;50:2215– 22.
3. Saclarides TJ. Rectovaginal fistula. Surg Clin North Am 2002;82:1261– 72.
4. Torbey MJ. Large rectovaginal fistula due to a cube pessary despite routine follow-up; But what is ‘routine’? J Obstet Gynaecol Res 2014;40:2162–5.
5. Margulies RU, Lewicky-Gaupp C, Fenner DE, McGuire EJ, Clemens JQ, Delancey JO. Complications requiring reoperation following vaginal mesh kit procedures for prolapse. Am J Obstet Gynecol 2008;199:678. e1–4.
6. Rosenshein NB, Genadry RR, Woodruff JD. An anatomic classification of rectovaginal septal defects. Am J Obstet Gynecol 1980;137:439–42.
7. Thompson JD. Relaxed vaginal outlet, rectocele, fecal incontinence, and rectovaginal fistula. In: Thompson JD, Rock JA, editors. TeLinde’s Operative Gynecology. 7th ed. Philadelphia: JB Lippincott; 1992. p.941.
8. Baden WF. Fundamentals, symptoms, and classification. In: Baden WF, Walker T, editors. Surgical Repair of Vaginal Defects. Philadelphia: Lippincott; 1992. p.9.
9. Expert Panel on Gastrointestinal Imaging, Levy AD, Liu PS, Kim DH, Fowler KJ, Bharucha AE, et al. ACR appropriateness criteria® anorectal disease. J Am Coll Radiol 2021;18:S268–82.
10. Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, et al. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum 2005;48:1337–42.
11. Corman ML. Anal incontinence following obstetrical injury. Dis Colon Rectum 1985;28:86–9.
12. Shieh CJ, Gennaro AR. Rectovaginal fistula: A review of 11 years experience. Int Surg 1984;69:69–72.
13. Göttgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO. The disappointing quality of published studies on operative techniques for rectovaginal fistulas: A blueprint for a prospective multi-institutional study. Dis Colon Rectum 2014;57:888–98.