Surgery for Small Trigonal Vesico-vaginal Fistula repair is demonstrated

Surgery for small Trigonal Vesico-Vaginal fistula 

repair is demonstrated in the video. 

youtube link for the demonstration of the surgery for 

Trigonal vesico-Vaginal Fistula Repair surgery

This is a case of small trigonal vesico-vaginal fistula. The patient is a young woman of 22 years, who had history of obstructed labour, when she was not able to deliver the child vaginally, she ultimately went to hospital for delivery. By that time the fetus had died in-utero, and since it was obstructed labours, the dead child was delivered by cesarean section. Soon after surgery, patient developed leakage of urine. The patient could not get proper treatment for 3 years after which she presented to us. The cystoscopy was done first to assess the size of vesico-vaginal fistula. There as small trigonal fistula present just below the inter-ureteric crest. Double J stenting was done. The vaginal opening was confirmed by vaginoscopy and instilling methylene blue dye in urinary bladder. The trans vaginal repair of the VVF with Martius flap interposition was taken. Spinal anaesthesia was given to patient and patient put in extended lithotomy position. After cleaning and draping the parts, the fistula is cannulated by foley's catheter. Adrenaline is instlled around the fistula as it minimizes bleeding and does hydro-dissection. The bladder is dissected from vaginal mucosa and bladder defect repaired in layers with 2-0 vicryl. The repair is done in two layers. The labial fat pad is dissected and a sub-mucosal tunnel is created and flap pulled through the tunnel and placed over the repair of the bladder. The flap is anchored to the bladder so that it does not get displaced. Finally the vaginal wall is repaired by suturing vaginal mucosa over the flap. The vagina is packed with betadine soaked gauze. The labial incision is closed over suction drain. in layers. .

 

The repair was successful and patient was dry after surgery. The Double J stents were removed after 3 weeks and cystoscopy and vaginoscopy confirmed successful repair of fistula.

Patient was fully continent and did not have stress incontinence.