Transabdominal repair of vesicovaginal fistula: an experience of 27 cases

To review the causes of vesicovaginal fistula and outcome of its repair through transabdominal approach. This is a descriptive cross sectional study which was conducted in Surgical "D" unit, Khyber Teaching Hospital Peshawar from January 2004 to December 2009. The record of all cases of vesicovaginal fistula that had undergone transabdominal repair was reviewed. Complex vesicovaginal fistula cases were excluded. Operative findings and procedure's details were obtained from operation notes. Post-operative follow up findings after one week, three weeks, forty days and three months were noted for every case. A total of 27 cases had undergone transabdominal repair for vesicovaginal fistula with age ranging from 26 to 63 years. Twenty two cases developed vesicovaginal fistula as a result of obstructed labour and five as a result of Gynaecological surgery [post-hysterectomy]. Mean post-operative hospital stay was seven days. Failure of repair was seen in one case only. Five cases were lost during follow up. Eight [29.63%] cases developed urinary tract infection, and two [7.40%] cases developed transient urinary stress incontinence. This study suggests that obstetrical trauma is the commonest cause for developing vesicovaginal fistula and the transabdominal approach gives satisfactory results in its repair

Outcome of mesh repair for incisional hernia

To determine the results of incisional hernia repair with prosthetic mesh. It is a retrospective descriptive study, conducted at Surgical "D" ward Khyber Teaching Hospital, Peshawar from January, 2002 to October, 2006. A total of 121 patients were included in this study. Those patients with incisional hernia, who were repaired with mesh and completed the minimum of 9 months of follow up, were included. Patients who were clinically diagnosed to have incisional hernia were admitted and after necessary preparation, were operated and defect in the abdominal wall was closed by a synthetic mesh. During the early post operative and follow up period, patients were looked for complications like seroma, infection, chronic discharging sinus formation and recurrence. Out of 121 patients, 73 were female and 48 were male. In most of the patients the incisional hernia resulted from emergency procedures. In 35 [28.9%] patients, there was post operative seroma formation, 17 [14%] patients had wound infection. one [0.8%] patient developed subcutaneous heamatoma due to unidentified bleeding which later on required evacuation under general anesthesia. Eight [6.6%] developed recurrence of hernia out of which some patients were treated by repeat Mesh repair. In 12 [9.9%] patients there was mild to moderate skin margin necrosis and in these cases debridement was a proof of successful treatment. Partial wound dehiscence was found in 3.3% of patients. Incisional hernia is more common in midline laparotomy wounds specially performed in emergency conditions and onlay mesh repair procedure has high acceptable outcomes