Extrasphincteric perianal fistulae after sacrospinous fixation for apical prolapse.
BACKGROUND
Delayed extrasphincteric perianal fistulae may be encountered after sacrospinous vaginal vault suspension or hysteropexy with permanent sutures.


METHODS
We report two cases of extrasphincteric perianal fistulae: one after a sacrospinous vaginal vault suspension and one after a sacropsinous hysteropexy. Reproduction of the vaginal dissection performed to place the sacrospinous fixation sutures failed to expose the sutures, and the fistulae persisted. Perianal fistulotomy and fistulectomy, however, resulted in identification and excision of the sutures.


CONCLUSIONS
Perianal fistulotomy or fistulectomy offers the most successful approach to identifying the inciting sutures.
From the Evanston Continence Center, Department of Obstetrics and Gynecology, Division of Urogynecology, and the Department of General Surgery, Division of Colorectal Surgery, NorthShore University Healthsystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
Adam
A
Gafni-Kane
Roger P
RP
Goldberg
James S
JS
Spitz
Peter K
PK
Sand
D000038:Abscess / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D011183:Postoperative Complications / Q000601:surgery*; D012003:Rectal Fistula / Q000209:etiology* / Q000601:surgery*; D013537:Sutures / Q000009:adverse effects*; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D014640:Vancomycin / Q000627:therapeutic use
D014640:Vancomycin; D011138:Polytetrafluoroethylene
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