PMC4619915_01
Showing anovestibular fistula in an adult female patient with openings of urethra and vagina. Note no separate anal opening.
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fig1
Perineal examination revealed no separate anal opening (Figure 1), dry stool seen through an opening in vestibule.
Exposure of operative area.
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fig2
Tractions sutures applied to expose the operative area (Figure 2), Inj. With the help of muscle stimulator sphincter complex was identified in the perineum and an opening made within it (Figure 5); electrocautery use minimized at this stage to prevent injury to sphincter complex (Figure 2).
Line of incision depicted around the anorectum.
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fig3
Circumferential incision was made around fistulous opening, as depicted in Figure 3.
Circumferential mobilization of anorectum.
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fig4
Posterior wall of vagina separated from the anterior wall of rectum anorectum is circumferentially mobilized up to the level of levator muscle (Figure 4).
New anal opening created.
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fig5
With the help of muscle stimulator sphincter complex was identified in the perineum and an opening made within it (Figure 5); electrocautery use minimized at this stage to prevent injury to sphincter complex (Figure 2). Tunnel was created through sphincteric complex and mobilised anorectum pulled down through it, fixed at the new opening within; thus anal transposition was done (Figures 5 and 6).
Anorectum transposed within sphincteric complex.
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fig6
Tunnel was created through sphincteric complex and mobilised anorectum pulled down through it, fixed at the new opening within; thus anal transposition was done (Figures 5 and 6).
Incision around the fistulous opening.
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fig7
Mobilisation of rectum.
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fig8
New anal opening marked with the help of muscle stimulator.
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fig9
Incision made at proposed new anal opening.
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fig10
Tunnel developed for mobilisation of rectum.
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fig11
Rectum transposed.
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fig12
Anoplasty completed.
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fig13