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Session: Abstract Session: Video

V3 - Martius Advancement Flap for Pouch-Adjacent Anovaginal Fistula

Monday, May 12, 2025
10:31 AM – 10:36 AM PT
Location: Ballroom 6B, Upper Level

    Author(s)

  • MM

    Matthew Meece, MD

    Fellow
    Allegheny Health Network Education Consortium (SVH)
    Erie, Pennsylvania, United States

    Disclosure information not submitted.

    • Video Abstract Presenter(s)

  • Meagan Derbyshire, MD (she/her/hers)

    Colorectal Fellow
    Allegheny Health Network
    Erie, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Selim Gebran, MD

    Resident
    Allegheny Health Network
    Pittsburgh, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • LT

    Lindsay Turner, MD, MSc

    Director of Urogynecology
    Allegheny Health Network, Department of Obstetrics and Gynecology
    pittsburgh, Pennsylvania, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Richard Fortunato, DO (he/him/his)

    Program Director, Colorectal Fellowship
    Allegheny Health Network
    Drexel University College Of Medicine
    Pittsburgh, PA, United States

    Disclosure information not submitted.

    • Submitting Author(s)

  • MM

    Matthew Meece, MD

    Fellow
    Allegheny Health Network Education Consortium (SVH)
    Erie, Pennsylvania, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Meagan Derbyshire, MD: This individual has no financial relationships with ineligible companies.
Selim Gebran, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Low rectovaginal (LRVF) and anovaginal fistulae are complex surgical diseases with high recurrence rates. Treatment outcomes are further complicated by previous surgeries and disease processes. The Martius advancement flap, first described in 1928, has been used for complex LRVF and anovaginal fistulae with good short- and long-term results. Spontaneous anovaginal fistulae are a described, but rare in the literature. We video describe a Martius advancement flap in a patient with an ileo-anal pouch and primary anovaginal fistula.

Methods/Interventions: We present a 48-year-old female with a confirmed history of Ulcerative Colitis and a previous total proctocolectomy with IPAA 15 years prior. The patient developed a spontaneous anovaginal fistula, at the dentate line, below the level of her pouch. The location was confirmed with pre-operative pouchoscopy, MRI and an exam under anesthesia. The patient then underwent a transperineal, transsphincteric fistulectomy with right-sided Martius advancement flap.

Results/Outcomes: The patient’s fistula was able to be fully excised without involvement of the ileo-anal pouch, or proximal ostomy diversion, and perineal reconstruction with Martius flap was performed without issue. The patient was admitted for observation overnight and discharged the next day. Final pathology of the fistula tract demonstrated acute and chronic inflammation with no dysplasia or IBD.

Conclusion/Discussion: Spontaneous anovaginal fistula are rarely described in the literature. We describe a successful transperineal Martius advancement flap in a patient with an ileo-anal pouch and primary anovaginal fistula.