We have been seeing increased number of Iatrogenic Vault Fistula specifically following abdominal hysterectomies.
In most cases, vaginal repairs were successful. However, in few women having very small VVF, the repair failed. They usually come after about a month or so and a lady who underwent hysterectomy 1 month ago came to us, we did repair and it failed. What could be the reasons for the failure? When is the best time to operate such patients? What next is advised in her case? Please enlighten us with your wisdom.
Dear sir
This fistula occurred after one month of surgery, means that it may be with a due to infection or neurotic due to stitch passed through bladder wall.
Give good antibiotics and then repair the fistula after 6months either laparoscopic or open surgery
One of the likely reason of failure is the associated difficult access of such fistulae making the essential broad base repair without tension a little difficult. It may also be that the fistulae were multiple and some were missed in the initial assessment and therefore repair.
Could trial of contineous bladder drainage possibly make the fistular close giving that it is small in size? I think the best time to go for a second surgery should be at least after 3 months of the first surgery. Thank you
Common causes of failure of fistula repair include difficult access with not enough dissection and mobilization, undiagnosed multiple fistulae, tension on sutures either during repair or postoperative due to blocked urinary drainage (commonest cause), also infection may have role.
Our protocol for another repair is after 3 monthes
Difficult coming from the scared vault usually appear challenge during the time of adenolysed the layers because of the scared tissue, and not all the small fistula can be repaired may left and healing spontaneous
- Badges
- Science topic
- Similar topics
- Mathematical Sciences
- Graphs