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Erschienen in:
01.03.2016 | The Last Image
Repair of a anastomotic-vaginal fistula with biological mesh (Permacol™) after surgery for low rectal cancer
Erschienen in: Techniques in Coloproctology | Ausgabe 3/2016
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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.
Fig. 1
Repair of the vaginal defect (arrow)
Fig. 2
The mesh sutured anteriorly to the external anal sphincter (arrow)
Fig. 3
The mesh sutured laterally to the puborectalis muscle (arrow)
Fig. 4
The mesh sutured proximally to the vaginal stump and lateral pelvic walls
Fig. 5
The exteriorization of the proximal colon before the coloanal anastomosis was redone
Fig. 6
Schematic illustration of the procedure
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