Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases

Abstract

Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. Methods: Retrospective observational study included 36 cases of open VVF repair, performed during 2010-2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O'Conor was performed and doubly folded peritoneal flap was utilized. Intra-and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of followup was done. Results: Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. Conclusion: Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.

A scoping review of tissue interposition flaps used in vesicovaginal fistulae repair

“…Standardized reporting of postoperative complications was performed in only three of the studies. 19 , 23 , 31 All postoperative complications are provided separately for each study in the Supplemental Table 2 . Studies with a standardized assessment of complications (according to the Clavien–Dindo classification) are summarized in Table 7 .…”

A New Technique to Repair Vesicorectal Fistula: Overlapping Rectal Muscle Plasty by Transanal Endoscopic Surgery

“…This new idea was conceived with reference to the theory of gracilis muscle interposition, which has been reported with preferable outcomes. A larger volume of muscle with sufficient blood flow, which interposed between 2 organs, is supposed to play an important role [30]. In addition, we hypothesized that a zigzag-shaped approximation line of muscle layer (Fig.…”

Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.

“…Obstructed labor is also an important risk factor of VVF. 10,11 Ojewola et al did transabdominal repair of VVF and reported success rate of 92.1% among those undergoing first time repair and success rate was 95.6% among those having failed previous repair via transvaginal route. 12 Bodner et al conducted study to see outcomes of VVF repair using transabdominal and transvaginal approaches and reported 97.8% success rate of vesico-vaginal fistula repair using transvaginal route while majority of the fistula (60%) were simple, 36% were complex and 4% fistula were complicated in their study.…”