Summary
Objective
To report the result of primary vesicovaginal fistula (VVF) repair using the transabdominal approach with omental or peritoneal flap interposition.
Methods
The study evaluated 38 patients who were treated with transabdominal approach with omental or peritoneal flap. The omental flap was used as the first choice if it was of sufficient length; otherwise, a peritoneal flap was created. Patients were followed postoperatively for 1 year and by telephone survey thereafter.
Results
The age of patients ranged from 29 to 68 years, with a median of 52 years. The main causes of VVF in this study cohort were hysterectomy for benign conditions (60.5 %), hysterectomy for malignant conditions (34.2 %), and radiation therapy (5.3 %). Peritoneal flap interposition was used in 6 patients and omental flap was used in 32 patients. All patients were continent following catheter removal. Overall, 89.5 % (34 out of 38) of fistulae were successfully repaired at first attempt. The success with omental flap interposition was 100 %. Recurrence of the fistula was reported in four patients (all with primary peritoneal flap interposition). Two of them were successfully cured by peritoneal flap re-interposition. While in two patients, with a history of radiation therapy, sigma rectum pouch was performed.
Conclusion
Transperitoneal surgical repair using omentum or peritoneal tissue interposition should be considered in the first attempt of repair of supratrigonal VVFs. However, successful repair depends on the experience of the surgeon.
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References
Singh O, Gupta SS, Mathur RK. Urogental fistulas in women, 5-years experience at a single center. Urol J. 2010;7(1):35–9.
Hilton P, Ward A. Epidemiological and surgical aspects of urogental fistulae: a review of 25 years experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(4):189–94.
Smith GL, Williams G. Vesicovaginal fistula. BJU Int. 1999;83(5):564–9.
Symond RE. Incontinance: vesical and urethral fistulas. Clin Obstet Gynecol. 1984;27(2):499–514.
Lee RA, Symmond RE, Williom TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313–9.
Hadzi-Djokic J, Pejcic TP, Acimovic M. Vesico-vaginal fistula: report of 220 cases. Int Urol Nephrol. 2009;41(2):299–302.
Haferkamp A, Wagener N, Buse S, Reitz A, et al. Vesicovaginal fistulas. Urologe A. 2005;44(3):270–6.
Eilber KS, Kavaler E, Rodriguez LV, et al. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6.
Graham JB. Vaginal fistulas following radiotherapy. Surg Gynecol Obstet. 1965;120:1019–30.
Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123(3):370–4.
Kelly J, Kwast BE. Epidemiologic study of vesicovaginal fistulas in Ethiopia. Int Urogynecol J. 1993;4:278–81.
Carr LK, Webster GD. Abdominal repair of vesicovaginal fistula. Urology. 1996;48(1):10–1.
O’Conor VJ, Jr, Sokol JK, Bulkley GJ, Nanninga JB. Suprapubic closure of vesicovaginal fistula. J Urol. 1973;109(1):51–4.
Goyal NK, Dwivedi US, Vyas N, Rao MP, Trivedi S, Singh PB. A decade’s experience with vesicovaginal fistula in India. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(1):39–42.
Pshak T, Nikolavsky D, Terlecki R, Flynn BJ. Is tissue interposition always necessary in transvaginal repair of benign, recurrent vesicovaginal fistulae? Urology. 2013;82(3):707–12.
Eisen M, Jurkovic K, Altwein JE, Schreiter F, Hohenfellner R. Management of vesicovaginal fistulas with peritoneal flap interposition. J Urol. 1974;112(2):195–8.
Kiricuta I, Goldstein BM. Use of the greater omentum in the treatment of vesicovaginal and rectovesicovaginal fistulae after radiotherapy and cystoplastie. J Chir Paris. 1965;89(4):477–84.
Kumar A, Goyal NK, Das SK, Trivedi S, Dwivedi US, Singh PB. Our experience with genitourinary fistulae. Urol Int. 2009;82(4):404–10.
Rasool M, Tabassum SA, Mumtaz F. Vasico-vaginal fistula repair urologist’s experience at Bahawalpur. Professional Med J. 2006;13:445–52.
Punekar SV, Buch DN, Soni AB, et al. Martius’ labial fat pad interposition and its modification in complex lower urinary fistulae. J Postgrad. 1999;45(3):69–73.
Horch RE, Gitsch G, Schultze-Seemann W. Bilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds. Urology. 2002;60(3):502–7.
Evans DH, Madjar S, Politano VA, Bejany DE, Lynne CM, Gousse AE. Interposition flaps in transabdominal vesicovaginal fistula repairs: are they really necessary? Urology. 2001;57(4):670–4.
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Hadzi-Djokic, J., Milojevic, B., Pejcic, T. et al. Vesicovaginal fistulas: transperitoneal surgical repair using omentum or peritoneal tissue interposition, a summary of 35 years of experience. Eur Surg 48, 47–50 (2016). https://doi.org/10.1007/s10353-015-0353-5
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DOI: https://doi.org/10.1007/s10353-015-0353-5