Repair of a anastomotic-vaginal fistula with biological mesh (Permacol™) after surgery for low rectal cancer

Excerpt

A 73-year-old woman, who had had hysterectomy and pelvic radiotherapy for cancer 8 years before, underwent laparoscopic total mesorectal excision (TME) with colopouch-anal anastomosis and ileostomy for a low rectal cancer. Anterior anastomotic leakage and necrosis of the posterior vaginal wall developed in the postoperative period leading to a 2 cm anastomotic-vaginal fistula. Two unsuccessful attempts at repair with a Martius flap were conducted before a transabdominal and transanal approach was attempted, suturing the vagina (Fig. 1) and placing a cross-linked collagen matrix mesh (Permacol™(Covidien)). The mesh was first fixed distally to the external anal sphincter and puborectalis muscle (Figs. 2, 3), then proximally to the upper border of the vaginal stump and to the lateral pelvic walls (Fig 4). A straight coloanal anastomosis (Figs. 5, 6) was finally performed. After 2 months the ileostomy was closed. There was no recurrence and functional outcome was good.

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