Extrasphincteric perianal fistulae after sacrospinous fixation for apical prolapse.

Background: Delayed extrasphincteric perianal fistulae may be encountered after sacrospinous vaginal vault suspension or hysteropexy with permanent sutures.

Cases: We report two cases of extrasphincteric perianal fistulae: one after a sacrospinous vaginal vault suspension and one after a sacropsinous hysteropexy. Reproduction of the vaginal dissection performed to place the sacrospinous fixation sutures failed to expose the sutures, and the fistulae persisted. Perianal fistulotomy and fistulectomy, however, resulted in identification and excision of the sutures.

Conclusion: Perianal fistulotomy or fistulectomy offers the most successful approach to identifying the inciting sutures.