Pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas (report of 67 cases) / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the therapeutic effects of pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas. Methods This series included 67 cases of complex vesicovaginal fistulas.Their mean age was 24 years (range,19-38 years). The disease course ranged from 6 months to 11 years (mean, 3.5 years).All the fistulas resulted from dystocia.The fistula outlet was 2.5-4.5 cm in greatest dimension with a mean of 3.0 cm.The complications included ureter vesicovaginal fistulas in 15 cases (left side in 5,right in 7 and both in 3),ureter orifice stricture in 4 cases (left side in 2,right in 1 and both in 1),hydronephrosis in 17 cases (left side in 7, right in 9 and both in 1),bladder calculi in 9 cases.The pedicled greater omentum displacement was performed to form a kind of protective "tightening screen", which covered the wound repaired between bladder and vesicovaginal fistula. Results The procedure was successfully completed at a single session of repair in 63 patients with a success rate of 94%.Two patients underwent further prolonged indwelling catheterization because of tiny vesicovaginal fistulas of 0.2-0.4 cm after initial operation.The procedure failed in 4 cases (6%).Among the 67 patients,ureterovesicoplasty was performed in 21 cases.After operation,29 patients (46%) had mild incontinence; of them 21 got successful further treatment.The follow-up was 3 months in the 63 cases with successful results.No vesicovaginal fistula occurred. However,8 cases had mild incontinence,and B-ultrasound and IVU showed mild hydronephrosis in 3 cases. Conclusions The operation by “tightening screen” to repair vesicovaginal fistulas through pedicled greater omentum displacement can improve the success rate of operation and allow the appropriate treatment of complications such as ureter orifice stenosis and fistulas.