Persistent peri-anal vaginocutaneous fistula/sinus tract associated with chronically infected synthetic transobturator mid urethral slings

Abstract

The objectives of our video are to highlight that persistent vaginocutaneous fistulas or sinus tracts can be associated with chronically infected macroporous (Type 1) synthetic transobturator slings, to discuss common presenting features and the importance of removal of the infected mesh and to demonstrate our surgical approach to excising chronically infected synthetic transobturator slings. We present a 61-year-old patient with a persistent non-healing right perianal vaginocutaneous fistula/sinus tract following incision and drainage of a right ischiorectal abscess 1 year prior. She has a history of transobturator tape sling placement 15 years prior for stress urinary incontinence and a subsequent vaginal mesh excision for vaginal mesh exposure 4 years prior. Her main complaint was persistent foul-smelling vaginal discharge and a non-healing right perianal wound. Despite undergoing multiple perianal debridement procedures her symptoms persisted. We had a high suspicion that her transobturator sling was the nidus for the persistent non-healing wound, thus we proceeded with an exam under anesthesia and right transobturator mesh excision. Removal of a transparent synthetic transobturator sling can be challenging. In this video we demonstrate our approach to removal of transobturator slings and discuss important surgical considerations to help with identification of transparent transobturator mesh slings. In conclusion, a strategic approach to transobturator synthetic mesh sling excision may allow for successful mesh identification and removal while minimizing complications.