We are getting a lot of iatrogenic fistula (VVF) referred from all over Nepal and repairing them with an excellent success and most of them do not have incontinence. Women are referred to us immediately after the development of fistula. We usually repair them after 6-8 weeks; when there is no inflammation and the tissue around fistula looks healthy. What is the usual practice in other parts of the world? When is the ideal time to repair those VVF’s? What are the factors that favor success here?
Please share experiences.
How are you repairing them? Vaginal or abdominal approach? Using an omental J-flap if repairing abdominally is helpful. If repairing them from the vaginal approach, a Martius flap helps add an additional tissue layer to the repair and added vascular supply.
Thanks Michael! We generally repair from vagina and do not use Martius flap.
Any other experinces??
Martius flap is not required always. We prefer 12 weeks. Individualise every case. By the way, how do you place the patient while repairing vaginally?
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