Gluteo-vaginal fistula: a long-term complication of posterior intravaginal slingplasty

Abstract

A 67-year-old lady presented to the surgical outpatient clinic with a 4 month history of recurrent purulent discharge from her left buttock. Four years and 4 months prior to this she underwent a posterior intravaginal slingoplasty for vaginal prolapse and urinary stress incontinence. An MRI demonstrated a long gluteo-vaginal fi stula tract from the posterior wall of the vaginal vault through the left ischiorectal fossa to the skin. An examination under anaesthesia revealed that the fi stulous tract was surrounding the intact mesh used for the posterior intravaginal slingoplasty. The mesh was removed, the fi stula tract excised and the perineal wound marsupialised. The patient was discharged 5 days later. The wound healed within 4 weeks and she remains sepsis free 2 years on.

Multidisciplinary Management of Cutaneous Gluteus Vaginal Fistula After Sacrospinous Ligament Fixation

“…The few reported cases of delayed presentation of postoperative gluteal vaginal fistula are associated with mesh placement for POP surgery and are secondary to extruded, infected, and eroded mesh occurring as long as 13 years after initial surgery. [1][2][3][4][5] Moreover, in the few reported cases on gluteal vaginal fistula associated with suture placement, the fistulas are secondary to migrated and exposed suture with vaginal exposure or tissue erosion, which may be more easily identified. [6][7] Sutures and mesh associated with Mersilene material, in particular, have been reported to be associated with complications in vaginal prolapse surgery, including vaginal exposure and tissue erosions.…”

“…Most reported cases of postoperative gluteal vaginal fistula are associated with mesh placement, slings, or tape. [1][2][3][4][5] This case report describes the surgical management of a patient who is 20 years post-SSLF presenting with persistent vaginal bleeding and cutaneous discharge due to gluteal abscess and cutaneous fistula, and provides a review of the existing literature on the subject.…”

Infection of Obturator Mesh Sling Masquerading as Fistula-in-Ano: A Case Report

“…Many were from the type 3 small pore polypropylene mesh, known to have higher rates of complications, including vaginal erosions as high as 13% 7–9 . Many of the infectious complications from synthetic materials were from placement of the “IVS tunneler,” which used the same thermally bonded tape as the previously mentioned “Obtape” to form “pseudo-uterosacral ligaments.” 10–12 Other rare reports of chronic draining sinuses and fistulas are from the use of braided permanent sutures such as mersilene (braided polyester) used for a sacrospinous vaginal suspension 13 . Although this is a likely underreported complication, the only 2 studies we were able to find reporting such delayed infectious complications with use of type 1 mesh used today included obturator slings 7 and 13 years later 14,15 …”