Mohammad Islam, Sajjad Ahmed.
Transperitoneal approach with interposition of omentum for the repair of supratrigonal vesico-vaginal fistulae.
J Med Sci Jan ;18(4):178-81.

Objectives: To determine the technical benefits and success rate of transperitoneal approach with interposition of omentum for the repair of supratrigonal Vesico-vaginal fistulae (VVF). Material and Methods: This study was carried out on 32 patients that were referred to our department from different gynae units and maternity homes of NWFP. Thirty-one patients had primary and one patient had recurrent VVF. The fistulae were approached transperitoneally, then Urinary bladder was opened between two stay sutures and closed by a single layered continous extramucosal suturing technique, the vagina was closed continuously with the suture passing through all layers. All the details of the patients were entered into a structured proforma. Results: Mean fistula size was 2.8 cm (range 1.0 to 3.7 cm). Mean operation time was 120 minutes and only one patient required a blood transfusion, and one patient required ureteroneocystomy. All except 2 patients who had a recurrence, were dry after 2-3 weeks. One patient had wound infection and another has had frequency of micturition. No patient suffered from peritonitis or adhesive intestinal obstruction. Conclusion: The transperitoneal approach is safe, effective and gives good access to the bladder and ureter as well as excellent functional results.

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