Anoplasty and rectovaginal fistula repair in a gilt with atresia ani: A case report.

A 2-year-old female Vietnamese potbellied pig was referred to the Large Animal Teaching Hospital at the Ontario Veterinary College for anoplasty and rectovaginal fistula repair. The presence of atresia ani and rectovaginal fistula had been previously diagnosed. Contrast radiography was used to confirm the diagnosis and determine the position of the fistula and terminal rectum. Under general anesthesia, the urethra was catheterized. An incision was made at the anatomic location of the anus, the rectovaginal fistula was isolated through deep dissection, and a Penrose drain was placed around it for caudal retraction. Transvaginal catheter placement through the fistula and into the rectum assisted with anatomic location. Once the urogenital and gastrointestinal tracts were clearly identified, the fistula was transected as close to the vaginal cavity as possible. The vaginal defect was sutured, and the fistula tract was mobilized 90° and sutured to the skin, creating the anal canal. Postoperative complications included constipation and cystitis. The gilt passed feces 5 d after surgery and was discharged on Day 11 of hospitalization. Normal urination and defecation were observed at the time, and fecal incontinence was resolved. Six months after surgical intervention, the gilt remained continent and no complications were reported. Key clinical message: Anoplasty and rectovaginal fistula repair were completed successfully in a gilt. Preservation of the fistula and its use during anal reconstruction may provide an internal anal sphincter and may be associated with improved continence.

Anoplastie et réparation de la fistule recto-vaginale chez une cochette avec atrésie anale : rapport de cas. Une femelle cochon vietnamien de 2 ans a été référée au Large Animal Teaching Hospital du Ontario Veterinary College pour une anoplastie et réparation d'une fistule recto-vaginale. La présence d'une atrésie anale et d'une fistule recto-vaginale avait déjà été diagnostiquée. Une radiographie de contraste a été utilisée pour confirmer le diagnostic et déterminer la position de la fistule et du rectum terminal. Sous anesthésie générale, l'urètre a été cathétérisé. Une incision a été faite à l'emplacement anatomique de l'anus, la fistule recto-vaginale a été isolée par dissection profonde et un drain de Penrose a été placé autour d'elle pour la rétraction caudale. Le placement d'un cathéter transvaginal à travers la fistule et dans le rectum a aidé avec la localisation anatomique. Une fois les voies urogénitale et gastro-intestinale clairement identifiées, la fistule a été sectionnée aussi près que possible de la cavité vaginale. Le défaut vaginal a été suturé et le trajet de la fistule a été mobilisé à 90° et suturé à la peau, créant le canal anal. Les complications postopératoires incluaient la constipation et la cystite. La cochette a expulsé des matières fécales 5 jours après la chirurgie et a obtenu son congé le 11e jour d'hospitalisation. Une miction et une défécation normales ont été observées à ce moment-là, et l'incontinence fécale a été résolue. Six mois après l'intervention chirurgicale, la cochette présentait encore de la continence urinaire et aucune complication n'a été signalée.Message clinique clé :L'anoplastie et la réparation de la fistule recto-vaginale ont été réalisées avec succès chez une cochette. La préservation de la fistule et son utilisation lors de la reconstruction anale peuvent fournir un sphincter anal interne et peuvent être associées à une meilleure continence.(Traduit par Dr Serge Messier).

Reconstruction of third-degree perineal lacerations in female camels (Camelus dromedarius) using a modified Goetz one-stage repair technique.

This study was designed to evaluate the modified Goetz-one-stage repair technique for reconstruction of third-degree perineal lacerations (TDPLs) in female camels. Fifteen female dromedary camels with TDPL were surgically reconstructed using the modified Goetz one-stage repair using the three-line closure technique. The surgical outcomes, the interval between repair and breeding, and the postoperative conception of the operated female camels were recorded and analyzed. During the 12-month postoperative follow-up period, TDPLs in 14 female camels (93.33%) healed completely by the first intention with mild inflammatory edema and infection in 2 female camels. One camel (6.67%) had a rectovaginal fistula, which was successfully repaired with suturing through the vaginal approach. Of the 15 female camels, 13 (86.67%) subsequently became pregnant through natural mating within 3 to 6 months postoperatively; however, 2 (13.33%) were one was immature and the other was barren which referred for gynecological treatment. The modified Goetz one-stage repair technique was successful in 14 of the 15 female camels after a single surgery, with a low incidence of postoperative complications. This technique is efficient for the repair of TDPLs in female camels, with promising results for subsequent fertility.

Surgical repair of third-degree perineal lacerations with rectovestibular fistulae in dairy cattle: a series of four cases (2010-2018).

We describe the successful surgical repair of third-degree perineal lacerations with rectovestibular fistulae in four cases using the single-stage modified Aanes method with purse-string suture of the vaginal vestibule and rectum. Fistulae formation and dehiscence of the repair were not observed after surgery. Two cows had five calves and one cow had four calves after surgery. The pregnant cows delivered normally. Additionally, there was no dehiscence of the suture line during the subsequent parturition. The breeding and fertility results obtained after the surgery are presented. According to the results of the present study, the modified Aanes method for the repair of third-degree perineal lacerations with rectovestibular fistulae appears to have a good prognosis for fertility following surgery in cows.

Atresia anal com fístula retovaginal em ovino: relato de caso / Anal Atresia with rectovaginal fistula in sheep: case report

A atresia anal com fístula retovaginal, é considerada uma afecção congênita rara nos ovinos. Em virtude disso, buscou-se descrever o reparo cirúrgico e cuidados pós-operatórios em uma borrega que apresentava essa afecção. Nesse sentido, uma borrega, sem raça definida, de 25 dias de idade e pesando 7,2kg, apresentou sinais de distensão abdominal e defecação pela vulva. A afecção foi diagnosticada por meio do exame clínico e confirmada radiograficamente, constatando-se atresia anal do tipo III em associação com a fístula.(AU)

Atresia ani associated with rectovaginal fistula is considered a rare congenital anomaly in sheep. Therefore, the surgical correction and post-operative care of a lamb presenting atresia ani with rectovaginal fistula has been detailed in this case report. A 25-days old, mixed breed lamb, weighing 7.2 kg, showing signs of abdominal bloating, and stool passage through the vulva was admitted at our hospital. An atresia ani type III condition associated with rectovaginal fistula was diagnosed by clinical examination and confirmed by radiographic examination.(AU)

Perineal choristoma and atresia ani in 2 female Holstein Friesian calves.

Atresia ani, a congenital anomaly of the anus, can be associated with other types of malformation. Two female Holstein Friesian calves had imperforate anus, rectovaginal fistula, and perineal choristomas. In one case, the choristoma was composed of mature adipose and fibrous tissue with nephrogenic rests. In the other calf, the choristoma consisted of fragments of trabecular bone coated by cartilage and containing marrow, mixed with mature adipose and fibrous tissue, striated muscle fibers, nerves, and vessels. This combination of malformations resembles the association of anorectal malformations and perineal masses in children.

A fistula flap technique for correction of type II atresia ani and rectovaginal fistula in 6 kittens.

OBJECTIVE: To report a surgical technique and long-term outcomes of type II atresia ani (AA) and rectovaginal fistula (RvF) correction, using a fistula flap technique in kittens. STUDY DESIGN: Clinical study. ANIMALS: Domestic shorthaired female kittens (n = 6) with type II AA-RvF. METHODS: Diagnosis of type II AA-RvF was made by clinical examination and vaginography. The anomaly was surgically corrected by a fistula flap technique for reconstruction of the anal canal and anus, and by vaginoplasty. Kittens were monitored for short and long-term complications. RESULTS: All 6 kittens were fecal and urinary continent in the immediate postoperative period. Postoperative complications occurred in 2 kittens: partial dehiscence between the anal and vaginal opening and a stenosis at the level of the rectal mucocutaneous anastomosis. Dehiscence healed by second intention and stenosis was treated by anoplasty. No long-term complications (median follow-up, 12 months; range, 12-17 months) were observed. CONCLUSIONS: Reconstruction of the anal canal and anus using the fistula as a local flap in combination with a vaginoplasty can be effective to treat feline type II AA and RvFs.

Surgical correction of rectovaginal fistula in mares and subsequent fertility.

OBJECTIVE: To evaluate the fertility of mares bred at various intervals relative to surgical management of rectovaginal fistula (RVF). MATERIALS AND METHODS: Surgical repair of RVF was performed in 28 mares at variable times relative to foaling (30 days to 24 months) and also relative to rebreeding (same cycle or delayed). Postoperative fertility was then evaluated. RESULTS: Two mares were already pregnant at the time of surgery and 20 of 23 mares (87%) that were bred immediately prior to or following surgery conceived from their first service. When mares were bred in the same cycle as surgery, the next cycle following surgery or in the following breeding season after surgery the pregnancy rate was 5/5, 5/6 and 10/12, respectively, and the foaling rates were 4/5, 4/6 and 7/12. The two mares already pregnant at the time of surgery foaled successfully. CONCLUSIONS: Excellent fertility can be achieved following surgical repair of RVF and our results suggest that delaying breeding until the following breeding season is not necessary. In addition, breeding in the same cycle as the surgical repair is a previously unreported technique that should be considered to maintain normal fertility and a yearly foaling interval.

Modified technique for the repair of third-degree rectovaginal lacerations in mares.

Eight mares with third-degree rectovestibular lacerations were treated by a two-stage surgical technique. The rectovestibular shelf was corrected with three parallel 'circular' continuous suture rows distributed along the longitudinal axis of the vagina, and the perineal body was reconstructed with three divergent simple continuous rows. Primary healing of the first-stage surgery occurred in all the mares. Seven of the mares completed the two-stage surgery and primary healing occurred in all of them. One of them returned to endurance racing competition and one was lost to follow-up. The other five were bred and became pregnant; one foaled four times, two foaled three times, one foaled once and the other was pregnant at the time of writing. The condition did not recur in any of the mares after foaling.

Rectovaginal fistula with anal atresia in 5 dogs.

Five dogs with rectovaginal fistula and atresia ani that had been treated by surgical correction of the malformations were studied retrospectively. Ages at presentation varied from 1 to 3 months and weight from 350 g to 7.5 kg. The histories included voiding of feces through the vulva, with or without tenesmus, usually observed after weaning. Atresia ani, presence of feces in the vaginal canal, abdominal distention, and discomfort on abdominal palpation were observed during clinical examination. Also, 3 dogs had partial tail agenesis. In all dogs, the rectovaginal fistula was isolated and transected, the vulvar and rectal defects were closed separately, and the atresia ani was repaired. Normal defecation was restored, but 1 dog had fecal incontinence that subsequently resolved. One dog died 2.5 months postoperatively, and follow-up was done on the others for periods ranging from 1.6 year to 7.7 years. Surgical correction in dogs with rectovaginal fistula and atresia ani may result in a favorable outcome, if it is done early.

Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinoma.

An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential.

Preservation of the fistula for reconstruction of the anal canal and the anus in atresia ani and rectovestibular fistula in 2 dogs.

OBJECTIVE: To report a technique for correction of atresia ani and rectovestibular fistula with fistula preservation, and outcome in 2 dogs. STUDY DESIGN: Case report. ANIMALS: Two intact female puppies. METHODS: The fistula was approached by episiotomy. A vertical median perineal incision was made starting dorsal to the anal region and extended to surround the fistula. The rectum and vagina were separated, and the end of the fistula was sutured to the skin. RESULTS: Early postoperative complications included constipation, fecal incontinence, and perineal soiling, but long-term outcome was good in both dogs. CONCLUSION: With careful dissection, the fistula and internal anal sphincter can be preserved and used in the surgical reconstruction of the anal canal and anus. CLINICAL RELEVANCE: Preservation of the fistula may provide an internal sphincter that contributes to a better functional result during correction of atresia ani. A surgical approach that combines episiotomy and perineal incision for separation of the vagina and rectum, and preserves the fistula may decrease the risk of dehiscence.

A vaginal mucosal pedicle flap technique for repair of rectovaginal fistula in mares.

OBJECTIVE: To describe the use of a vaginal mucosal pedicle flap for repair of rectovaginal fistulae (RVF) in mares. STUDY DESIGN: Clinical case report. ANIMALS: Three mares with RVF. METHODS: After debriding the RVF, a dorsally based U-shaped mucosal and submucosal pedicle flap (2-4 mm thick) was dissected from the vaginal wall, rotated approximately 90 degrees angle to close the ventral aspect of the fistula and sutured in position with 10-13 single sutures that did not penetrate the rectal mucosa. This positioned the vaginal mucosa so that it was continuous with the rectal mucosa. RESULTS: Two RVF healed by 1st intention whereas for the 3rd RVF, 2 additional single sutures were required to repair partial dehiscence after 10 days. At 6 weeks and 6 months all RVF were healed. One mare subsequently foaled without complications. CONCLUSIONS: RVF can be closed by use of a rotation flap of vaginal tissue. CLINICAL RELEVANCE: Tension-free closure of RVF can be achieved by rotating a pedicle flap of vaginal mucosal tissue without undue wound tension, and should be considered as an alternative to conventional appositional techniques.

A case of atresia ani with rectovestibular fistulae in an alpaca (L. pacos).

This communication reviews the generally accepted embryological development of rectovestibular fistulae and describes in detail, the diagnostic procedures and clinical findings of this condition in an alpaca (L. pacos). Specific modalities are detailed which facilitate this diagnosis in an animal with atresia ani. Comments are also directed to the incidence, reporting, and documentation of this and related conditions in South American camelids.

A one-stage repair of third-degree perineal lacerations and rectovestibular fistulae in 17 mares.

Third-degree perineal lacerations or rectovestibular fistulae in 17 mares were repaired surgically by a one-stage method. Primary healing occurred in 14 mares; there were one complete dehiscence and two partial dehiscences with fistula formation. Twelve of 13 mares that were bred became pregnant; nine carried foals to term and two are still pregnant. Two mares have each produced one unthrifty foal. One mare repeatedly aborts in the first trimester. Four mares have produced several healthy foals with no further problems. One mare suffered further perineal trauma while foaling.

Comparison of endometrium before and after repair of third-degree rectovestibular lacerations in mares.

The endometrial response of mares to repair of third-degree rectovestibular lacerations was evaluated. Endometrial biopsy specimens from 8 mares with third-degree rectovestibular laceration were obtained immediately before surgery and from 9 to 15 days after repair. Presurgical endometrial biopsy specimens were classified as category I for 2 mares; category II, attributable to slight endometritis, for 5 mares; and category III, attributable to moderate-to-severe endometritis, for 1 mare. Within 15 days after rectovestibular repair, all endometrial biopsy specimens were classified as category I. Results indicated that mares with third-degree rectovestibular injuries are candidates for breeding by artificial insemination by 2 weeks after repair of the injury.

Rectovaginal fistula with atresia ani in three kittens.

Rectovaginal fistula with atresia ani was diagnosed in 3 kittens. Physical abnormalities included abdominal distension, bulging of the perineum, and lack of an anal opening. Vaginography was helpful in determining the type of malformation present in 2 cases. In each kitten attempts were made to surgically correct the anatomic malformations. Various post-operative complications such as fecal incontinence, would dehiscence, constipation, and excessive scar tissue formation occurred and are discussed.

Standing urogenital surgery.

Caslick's, episioplasty, urethroplasty, cervical, and rectovestibular laceration repair are, by preference, performed in the standing patient. Normal castration is performed routinely uneventfully in the standing patient. The duration of the procedures and the ease with which they are accomplished in a standing horse of normal temperament make general anesthesia unnecessary. More invasive procedures, such as removal of urinary bladder calculi in male horses or removal of a neoplastic ovary in a mare, can be accomplished in a standing patient but serious consideration should be given to the use of general anesthesia. For these procedures, the potential complications are increased while the ability to effectively deal with those complications is diminished in a standing patient. For instance, imagine a mare that lays down in the stocks during a standing flank removal of an ovary or a stallion that defecates during a Gokel's approach to the bladder. Only extenuating circumstances justify these risks when general anesthesia is available.