RT Book, Section
A1 Arrowsmith, Steven
A2 Rogers, Rebecca G.
A2 Sung, Vivian W.
A2 Iglesia, Cheryl B.
A2 Thakar, Ranee
SR Print(0)
ID 1105832676
T1 Fistula Repair
T2 Female Pelvic Medicine and Reconstructive Surgery: Clinical Practice and Surgical Atlas
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-175641-9
LK obgyn.mhmedical.com/content.aspx?aid=1105832676
RD 2024/04/19
AB Obstetric  fistula  (OF),  although  virtually  eradicated  from  the  developed  world,  has  a  number  of  unique  features  that  make  this  topic  worthy  of  the  attention  of  practitioners  of  pelvic  surgery  anywhere.  A  discussion  of  the  steps  of  repair  of  OF  is  useful  to  all  pelvic  surgeons  because  of  the  relative  difficulty  of  repair  of  OF  compared  with  other  types  of  vesicovaginal  fistula  (VVF).  The  etiology  of  OF  is  wide-field  ischemia.1  OF  injuries  tend  to  be  much  larger,  with  more  tenuous  vascular  supply,  and  located  in  physiologically  more  important  anatomic  areas  when  compared  with  fistulae  seen  in  wealthy  countries.2  Therefore,  if  one  can  appreciate  the  basic  principles  of  OF  repair,  all  will  apply  to  the  much  simpler  problem  of  postoperative  VVF  as  seen  in  the  West.  The  techniques  of  OF  repair  also  are  well  employed  in  the  challenging  area  of  postirradiation  fistulae,  which  share  some  features  with  OF.  Figures  36-1  and  36-2  demonstrate  longitudinal  and  vaginal  views  of  large  circumferential  VVFs  that  demonstrate  some  of  the  complexity  of  these  types  of  fistula.