@susanf8 not really sure what caused the fistula, but I have my suspicions. I noticed an unusual bulge in my vaginal area approximately 15 years ago. I went to a rectal physician who diagnosed it as a rectocele. About five or so years ago, I noticed air discharge from the area and upon palpitation I could feel a small bump. I guess this was probably the beginning of the fistula. I was referred to a gynecologist who said he would be unable to repair it because my entire rectum was removed and there’s no tissue for a rectal flap. I guess that’s the main issue the rectal surgeon in Dallas had. He tried to sew up the fistula and that did not work. I have no problem with traveling to the Mayo Clinic, but I think we have fabulous physicians in Texas, I just need to find one that has experience with my particular issue. I would not be against using mesh to seal the fistula, although no one uses mesh anymore, except with hernia repair in the abdomen area. I guess I’m just searching for a surgeon who’s had experience with this kind of issue.