Post-Operative Tract Irrigation After Bartholin's Fistula Repair
Do not irrigate the fistula tract after surgical repair of a Bartholin's gland fistula to the fourchette, as this risks disrupting the healing process and potentially introducing infection into a surgically closed tract.
Rationale Against Tract Irrigation
The evidence strongly suggests avoiding irrigation of surgically repaired fistula tracts in the perineal region:
Wound irrigation is intended for open wounds, not surgically closed tracts. The purpose of irrigation is to physically remove debris, bacteria, and foreign material from exposed tissue surfaces 1.
Vigorous irrigation can remove protective immunologic cells that enable healing through natural inflammation, granulation, and re-epithelialization processes 1.
Forcing fluid into a closed fistula tract could disrupt the surgical repair, potentially reopening the tract or introducing bacteria deeper into tissue planes 1.
Specific Concerns for Bartholin's Fistulas
Bartholin's gland fistulas to the fourchette are rare complications that require careful post-operative management:
These fistulas are typically managed with surgical excision and fistulectomy with complete resolution achieved through antibiotics and wound care, not irrigation 2.
Recurrent fistulas in this location may require advanced techniques such as Martius flap procedures, which depend on undisturbed healing of tissue layers 3.
The anterior perineum in females has unique anatomical considerations with a short anterior sphincter complex that makes any intervention in this area high-risk for complications 1.
Appropriate Post-Operative Care
Instead of irrigation, focus on:
Systemic antibiotic therapy to prevent infection while the surgical repair heals 2, 3.
External wound care only - keeping the perineal area clean with gentle cleansing of the skin surface, not the tract itself 1.
Monitoring for signs of abscess formation or fistula recurrence including pain, swelling, purulent drainage, or passage of flatus/stool through the vagina 4, 3, 5.
Critical Pitfall to Avoid
The most important principle is that a surgically repaired fistula tract should be left undisturbed to heal. Irrigation is only appropriate for open wounds or tracts that are intentionally left open to drain (such as with seton placement in Crohn's disease) 1. Your patient has undergone surgical closure, which is fundamentally different from drainage procedures 3, 5.