The purpose of the following study is to report our experience of laparoscopic ugf repair with emphasis on important steps for a successful laparoscopic repair. Prognostic factors of recurrence after vesicovaginal. Controversies also exist regarding approach and technique of repair. In the majority of cases, vvf requires only multilayer tension free repair. Furthermore, some patients may simply not be candidates for repair due to coexistent medical morbidities. Previous operation nil nil nil 2 times failed vvf repair confirmatory investigation. Failed vvf repair is often labeled as complicated repair and thus is relegated to the interposition omental. The literature suggests that an omental interposition flap during a vvf repair will increase the chance of surgical cure. An irb approved retrospective study revealed 44 female patients. Entrapped urinary calculi in iatrogenically created.
Vesicovaginal fistula vvf is a subtype of female urogenital fistula ugf. Some surgeons believe interposition flaps should be used not only in complicated vvf repairs but also in all vvf repairs, to enhance surgical success 3, 4. Expand the upload pdf files dropdown and select your files. If there is any doubt, a dye test should be performed. As logical as this proposal might seem, prospective randomized. Upload corrupt, incomplete or damaged pdf files which other programs fail to open or edit, and this tool will give you multiple recovery options.
First steps in vesicovaginal fistula repair i know of no other condition where such a variety exists from the simplest case, which can be completed in half an hour, to the most dif. Maisonneuve and mackenrodt each described the key technique that involves separating the bladder from. A fistula is an abnormal connection between an organ and another structure a vesicovaginal. In some cases, surgical repair of a vvf will fail repeatedly, probably due to existing pelvic malignancy, severe radiation damage, andor large soft tissue loss, especially in the setting of obstetric fistula. Dragging and dropping files to the page also works. The variety of problems encountered is enormous, which is why it takes so long to become an expert. Depending on how much the pdf is damaged we will be able to recover it partially or completely. Laparoscopic repair of vesicovaginal fistula journal of. Generally, vvf occurs 16 weeks after gynaecological or obstetric surgery, while recurrent fistula can develop within the first 3 months after primary repair 2. In this case study, the doctors report on a patient with a history of cystotomy repair at the time of a hysterectomy who failed a laparotomy approach to a vvf repair using an omental flap. Transvaginal repair of apical vesicovaginal fistula.
A 53yearold female developed a vvf after she underwent an abdominal hysterectomy for uterine fibroids at an outside facility. Data of patients who underwent laparoscopic repair of ugf from 2003 to 2012 was retrospectively. Vesicovaginal fistula failing multiple surgical attempts. Vesicovaginal fistula vvf has been a social and surgical problem for centuries.
In 3 patients operated abdominally the vvf repair was successful. Vesicovaginal fistula vvf repairs are commonly described using either a laparoscopic, abdominal, or vaginal approach. Local factors like size, location, and previous radiotherapy as well as surgeons experience are detrimental in deciding for vaginal or. Rhabdomyolysis and myogloginuric acute renal failure in. Vesicovaginal fistula surgery description primary vvf n 1 prior failed repair vvf n greater than 2 prior. Fistula repair patient testimonials urogynecologists. Uncorrected proof female urology incontinence supratrigonal vvf repair by modi. The choice of repeat surgeries after failed primary surgeries for female stress urinary incontinence, 1997. Failed vvf repair is often labeled as complicated repair and thus is relegated to the interposition omental flap paradigm. Repair pdf file upload a corrupt pdf and we will try to fix it.
Even in cases of previous failed repair, transvaginal vvf repair has a very high success rate. The surgery was delayed by more than six months due to the patients work schedule and time commitment to her children and family. Conservative measures include proper and undisturbed bladder drainage for several weeks, treatment with antibiotics when indicated and in some. Vesicovaginal fistula vvf is still a major cause for concern in many developing countries. Laparoscopic extravesical vesicovaginal fistula repair. An experience of 26 cases divakar dalelaa, priyadarshi ranjanb, pushpa lata sankhwarc, satya n. Transvesicoscopic bipolar sealing of vesicovaginal fistula. Obstetric vvf related to prolonged labor remains a major medical problem in many underdeveloped. To describe a methodology for laparoscopic repair of vesicovaginal fistula vvf, and to provide a comparison of results between a series of laparoscopic repairs, a series of transabdominal open repairs taors, a series of transvaginal repairs tvrs, and cases successfully managed without surgery patients and methods. Arguments continue as to the best approach for repair. How to repair a vesicovaginal fistula brian hancock retired fistula surgeon, east and west africa correspondence.
For vvf, transvaginal or transabdominal approach depends on the location of the fistula, relation with the ureteric orifice. Click upload pdf files and select files from your local computer. Out of 29 patients, 27 patients had an immediate successful result table3. It has been stated that the best opportunity to achieve successful repair of vvf is with the initial operation 1. When conservative treatment has failed and leakage of urine continues per vaginum despite good bladder drainage, surgical correction of the fistula becomes necessary. A successful repair of such fistulas requires an accurate diagnostic evaluation and timely repair using procedures that exploit basic surgical principles and the application of interposition flaps. Many surgical techniques have been developed to correct this abnormality, including transabdominal, transvaginal, and endoscopic approaches. Pdf model predicting failure in surgical repair of. When the repair is done by an abdominal approach omentum is. The early vs delayed repair of vvf has been debated. However, patients given prophylactic antibiotic therapy did have fewer urinary infections and required less antibiotic therapy postoperatively. Our series also includes 11 patients, who had a total of 16 failures, with recurrent vvf, including 3 patients in whom vvf repair failed, despite the use of an omental flap 14. In 1935, while performing a dissection on an egyptian mummy a queen of the 11 th dynasty, circa 2050 bce, derry noted a large vvf that he concluded was the consequence of obstructed labor. The subsequent successful repair was performed using a laparoscopic approach using a layered closure technique without an interposition omental flap.
It gives you a list of tools to try and fix a pdf file by rewriting the file structure or filtering out broken pages. Hence, the management protocol is dependent on the treating surgeon and the available resources. Vesicovaginal fistula has been a social and surgical problem for centuries. Sparse literature exists on laparoscopic repair of urogenital fistulae ugf. Sankhwara, vineet najaa, apul goela adepartment of urology, king george medical university, lucknow, up, india bdepartment of surgery, king george medical. In patients with more than 2 previous failed repairs, abdominal vvf repair with omental flap remains a very effective salvage procedure. In 1861, maurice collis was the first to report a layered closure technique, and in 1893, schuchardt described a pararectal incision to facilitate improved exposure for the repair of a high vvf.
Maternity unit, monze mission hospital, monze, southern province, zambia department of public health and epidemiology, the medical school, university of. Trendelenburg, in 18811890, described a suprapubic approach. Two types of laparoscopic vesicovaginal fistula vvf repairs, the traditional transvesical oconor and extravesical techniques, dominate the literature. Transvaginal route for repair is preferred as it has low morbidity, higher success rates, and minimal complications. However, when complicating factors such as prior failed surgery or poor quality of tissues occur, adjuvant measures are required. We present our 15year experience of primary and recurrent cases of vvf utilizing an extravesical technique, which we first described in 1999. Due to the recurrence of the vvf, a da vinci robot assisted laparoscopic extravesical repair with omental intraposition graft was proposed to repair the persistent vvf. When vvf is large or does not respond to conservative measures, surgical correction is indicated, with a success rate of 75 97% in cases of. Conservative methods should be used in carefully selected patients.
Previous failed attempts at repair produce scar and anatomic distortion and may. In their series of 79 patients who underwent repair of a vvf by a single surgeon, they found intraoperative ampicillin did not reduce the odds of failed repair. Management of vesicovaginal fistulas vvfs in women. Female urology incontinence supratrigonal vvf repair by modi. Patients who had previous failed repairs at the fistula centre had better outcomes after the repeat surgeries. Bimbola kemi odu faculty of education, ekiti state university adoekiti, nigeria abstract this paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. In direct contradiction to the epidemiology of repair is directed at prevention of repair failure vvf in the industrialized world, 96. Background vesicovaginal fistulas vvf are the most commonly acquired fistulas of the urinary tract, but we lack a standardized algorithm for their management. Sankhwara, vineet najaa, apul goela adepartment of urology, king george medical university, lucknow, up, india bdepartment of surgery, king george medical university, lucknow, up, india. Out of 24 patients 7 patients had prior fistula repair attempts 12 without success while 17 had no previous attempts of repair of fistula. Based on our experience, it is easier to repair fistulas in these failed cases compared with firsttime cases, because the failed cases have single and smaller fistula after our initial alternative. Vesicovaginal fistula, or vvf, is an abnormal fistulous tract extending between the bladder vesica and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. The best approach is probably the one with which the surgeon feels most experienced and comfortable. The main complication of vvf surgery is recurrent fistula formation.
The method of closure depends on the surgeons training and experience. Surgery is the most commonly preferred approach to treat women with primary vvf following benign gynaecologic surgery. The proper timing for corrective surgery and the ideal type of procedure is currently controversial 5. All procedures were of prolonged duration mean five hours and ten minutes. The bladder should be exposed and mobilized from above and opened in the midline to inspect the interior. Abdominal hysterectomy remains as the most common cause of vesicovaginal fistulae vvf in developed countries, occurring in 11,800 hysterectomies. Robotic repair of vesicovaginal fistula vvf sotelo. A fistula is an abnormal connection between an organ and another structure. Outcome of transvaginal vesicovaginal fistula repair with. The objective of this video is to demonstrate a technique for robotassisted vesicovaginal fistula vvf repair utilizing a mini cystotomy with a transvesical approach. A vesicovaginal fistula repair procedure involves the repair of the vesicovaginal fistula in women. Vvf is still a very troublesome complication of obstetric and gynecological procedure in developing countriestissue interposition is often required for repair of complex vesicovaginal fistula.
This study aimed to present our experience with transabdominal vvf repair. Michael s archibong 1, oluwole e ayegbusi 1department of obstetrics and gynaecology, obafemi awolowo university teaching hospitals complex, ileife, osun state, south west,nigeria. One patient developed vvf following radiotherapy for carcinoma cervix and she was advised repair after one year. Sometimes, vvf repair has failed after 4 years, necessitating a urinary diversion. She was referred to us following two failed vvf repairs one. Delayed repair is better than the early repair of vvf. The purpose of this study was to develop a score to predict the factors influencing failure in surgical repair of obstetric vesicovaginal fistula vvf in the southeastern part of the province of.
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