Supratrigonal VVF repair by modified O'Connor's technique: an experience of 26 cases.

نویسندگان

  • Divakar Dalela
  • Priyadarshi Ranjan
  • Pushpa Lata Sankhwar
  • Satya N Sankhwar
  • Vineet Naja
  • Apul Goel
چکیده

OBJECTIVE To report the technical modifications of O'Connor's procedure and their outcome in 26 supratrigonal vesico vaginal fistulae. MATERIALS AND METHODS Twenty-six cases of supratrigonal VVF (17 primary, 9 recurrent) were operated using the described modifications. It consisted of approaching the bladder transperitoneally, without dissecting the retropubic space, making a short sagittal or parasagittal cystotomy in between stay sutures, liberal use of bladder rotation flaps instead of midline closure, using single layer, continuous, closely placed, interlocking stitches for bladder as well as vaginal approximation and universal use of vascularised tissue interposition. RESULTS Mean fistula size was 2.8 cm (range 1.0 to 3.7). Mean operative time was 104 minutes, and blood loss was insignificant. Three patients required ureteroneocystostomy. All patients were dry after 2-3 weeks of suprapubic and per urethral catheter drainage. One patient persisted with stress urinary incontinence. No patient on follow up complained of features suggestive of prolonged ileus, peritonitis or adhesive intestinal obstruction. CONCLUSION Modified O'Connor's repair is safe and achieves excellent functional results. It requires a shorter cystotomy instead of bi-valving of the bladder, thus minimizes tissue trauma, intraoperative blood loss and operating time. It also gives option of tailoring the cystotomy in sagittal or parasagittal line, according to the site and size of the fistula, and thus permits closure of fistula by rotation of bladder flap into the defect without any lateral traction on the bladder edges. Retropubic dissection and drainage of the retropubic space is also not required.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Transperitoneal transvesical laparoscopic repair of vesicovaginal fistulae: experience of a tertiary care centre in northern India.

OBJECTIVE To present our experience of treating supratrigonal vesicovaginal fistulae by laparoscopic technique and their long-term follow-up. MATERIAL AND METHODS Between January 2008 and June 2012, 28 cases of supratrigonal fistulas were repaired by laparoscopic transperitoneal transvesical technique with interposition flap. The obstetric fistula was present in 18 and gynecologic fistula in ...

متن کامل

Robotic repair of vesicovaginal fistula - initial experience

______________________________________________________________________________________ Objective: The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF) (1) posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Mater...

متن کامل

Iatrogenic vesicovaginal fistula.

OBJECTIVE To find the frequency of iatrogenic VVF in patients admitted for repair of VVF in Lady Willingdon Hospital, Lahore. STUDY DESIGN An observational study. PLACE AND DURATION OF STUDY Lady Willingdon Hospital, Lahore, from January 2007 to December 2008. METHODOLOGY All cases of VVF treated at the centre during the study period were included in the study. The patients were admitted ...

متن کامل

Robotic repair of a vesicovaginal fistula in an irradiated field using a dehydrated amniotic allograft as an interposition patch

We report the case of a 66 year old female with a supratrigonal vesicovaginal fistula (VVF) that developed after undergoing radical hysterectomy, chemotherapy and pelvic radiation therapy for advanced cervical cancer. VVF repairs in an irradiated field are known to be complicated procedures with significant morbidity and a high rate of failure due to the effect of radiation. Amniotic membranes ...

متن کامل

Arthroscopic Meniscal Repair: “Modified Outside-In Technique”

Background:  Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “ modified outside-in technique ” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • European urology

دوره 49 3  شماره 

صفحات  -

تاریخ انتشار 2006