Question: After a total hysterectomy with bilateral salpingectomy, is it common to get perianal or vaginal fistula?
Answer from Dr. Daniel Gruber, urogynecologist from Sibley Memorial Hospital in Washington D.C., part of John Hopkins medicine.
This is relatively uncommon, especially this kind of fistula. A fistula is more common, but still pretty unusual.
A vesicovaginal fistula is a fistula on the connection between the vagina and bladder. In the western world, the most common reason for this to happen is after surgery. In third world countries, it’s often more of an obstetrics situation because the baby has been sitting on that area for a long period of time without treatment. This can cause a connection between the various different structures.
A rectovaginal fistula is one where there’s a connection between the rectum and the vagina. Perianal means just around the anus. That is actually more common with conditions such as Crohn’s Disease. In some cases, it can also be caused by obstetrical situations like I mentioned before.
Typically, it depends on what kind of surgery you had done. If it’s just a hysterectomy, then a rectovaginal fistula would be highly unusual. It could be different conditions. For example, there’s poor healing conditions, smoking cigarettes, and diabetes. So it gets a little more complicated.