Successful Resolution of a Chronic Post-hysterectomy Rectocutaneous Fistula Using Transanal Minimally Invasive Surgery (TAMIS)

Colocutaneous fistulas are a rare but challenging complication of abdominal and pelvic surgery. Their surgical management can be difficult, especially when associated with multiple failed treatments. Transanal minimally invasive surgery (TAMIS), initially designed for local excision of rectal tumors, has been increasingly used in complex benign conditions. We present the case of a 41-year-old female patient with a chronic rectocutaneous fistula that developed following a hysterectomy and had persisted despite four failed endoscopic clip placements. The patient also reported intermittent passage of air through the vagina; however, no rectovaginal communication was identified through imaging, endoscopy, or intraoperative exploration. The fistula orifice was located 15-16 cm from the anal verge and was approached using a TAMIS platform, allowing for direct endoluminal access and precise intracorporeal suturing. The procedure lasted 65 minutes, with minimal blood loss. The patient had an uneventful recovery and was discharged 48 hours later. Long-term follow-up at three years demonstrated complete and durable resolution of the fistula, without recurrence or complications. This case illustrates the utility of TAMIS in the definitive management of complex post-hysterectomy rectal fistulas and supports its use as a safe and effective alternative to more invasive procedures in selected non-oncologic cases.