The ideal intervention in the treatment of perianal fistula prevents the onset of infection to speed healing and prevent fistula recurrence while maintaining the function of the anal sphincter. Currently, there is no consensus on the best recommended surgical technique for perianal fistula management. Several studies have shown that fistulotomy was an easy and safe procedure for treatment of perianal fistula. Lateral internal sphincterotomy is the usual procedure performed on an anal fissure to decrease the anal sphincter tone. This study reports a combination of fistulotomy and contralateral internal sphincterotomy procedures for recurrent and complex perianal fistula to prevent recurrence. Here, we report 5 cases of recurrent and complex perianal fistula. The combination of fistulotomy and contralateral internal sphincterotomy is a relatively easy and safe procedure for complex perianal fistulae. In our cases, we found neither recurrence nor postoperative anal incontinence.

Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.

Introduction: Sigmoid colon vaginoplasty is a surgical procedure for the management of vaginal agenesis cases. This technique produces a neovagina that can function as a menstrual blood outlet as well as on penetration during sexual activity. Methods: A retrospective case study of vaginal agenesis, where sigmoid colon vaginoplasty surgery was performed at Dr. Sardjito Hospital Yogyakarta Indonesia in 2016-2018. The following post-surgical evaluation were assessed by observing the vaginal function to drain menstrual blood out, as well as function on penetration during sexual activity. Results: Sixteen cases of vaginal agenesis surgically performed were reported. Identification of the reproductive organs was carried out, in which 3 patients were without uterus, and 13 patients had menstrual uterine function. The length of sigmoid colon graft was around 15-20 cm. There were no complications during surgery. Post-surgical evaluation of 5 cases who have been married, all have been able to penetrate in sexual activity without meaningful complaints. All cases that had a uterus underwent regular menstrual cycles, with no dysmenorrhea. It can be said as a whole that this surgical procedure can be accepted by the patients, because it produced good vaginal function. Conclusions: Sigmoid colon vaginoplasty was a surgical procedure for congenital vaginal agenesis with satisfactory results. There were no complaints of dyspareunia or post-surgical dysmenorrhoea, resulting in a good cosmetic appearance of the external genitalia, and relatively mild complications.