Urogynecologist Mayo Clinic Arizona Phoenix, Arizona, United States
Objectives: To demonstrate primary repair of an anovaginal fistula.
Methods: Step by step video presentation of primary anovaginal fistula repair. We report the case of a 47-year-old who experienced a 4th degree laceration following vaginal delivery 24 years ago. She had been asymptomatic until 1 year ago; she noticed gas and occasional fecal matter passing through the vagina. Given that the fistula was well matured, and she did not have an inflammatory bowel condition, primary repair was performed. The fistula tract is removed, and a tension free, multilayered closure is performed. The patient had an uneventful recovery with no evidence of recurrence 5 months later.
Clinical Relevance: An anovaginal fistula is an abnormal connection between the anal canal and the vagina leading to the passage of stool or gas through the vagina. The symptoms of an anovaginal fistula can play a significant impact on a woman’s physical and psychological well-being. Small anovaginal fistulas of obstetric origin in which the anal sphincter complex remains intact can be repaired by simple fistulectomy with immediate reconstruction. The success rate of surgical repair of simple anovaginal fistulas is reported to be between 70-90%. The success rate can vary depending on the patient's underlying health status, and the location and size of the fistula. In some cases, a second surgery may be necessary to achieve complete closure of the fistula.
