Sohail Mahmood Ch, Bushra Lali.
Use of Pedicled Omental Graft as an Aid to Vesicovaginal Fistula Repair.
J Surg Pak Jan ;22(1):25-8.

Objective: To determine the role of omental graft in the outcome of vesicovaginal fistula (VVF) repair. Study design: Descriptive case series. Place & Duration of study: Department of Obstetrics and Gynecology Unit 1, Bahawal Victoria Hospital / Quaid-eAzam Medical College Bahawalpur, from June 1997 till December 2016. Methodology: All patients with VVF were included in this study. All had uncontrolled continuous loss of urine. In all cases examination under anesthesia was done. Transabdominal approach was used in all patients. Adequate dissection of bladder from anterior vaginal wall was achieved and fistula repaired. Omental pedicle graft was interposed between bladder and vagina. The distal part of the omentum was stitched to the distal limits of the space between bladder and vagina. Bladder drainage with three way Foley catheter was maintained for 21 days. Results: Of the total 144 patients with VVF, 43 (29.8%) developed this complaint after obstructed labor, 23 (15.9%) following cesarean hysterectomy, 6 (4.1%) after cesarean section, 44 (30.5%) after total abdominal hysterectomy (TAH), 6 (4.1%) after vaginal hysterectomy, 3(2%) after post coital trauma, 19 (13.2%) after failed earlier repair. Of the total, 140 (97.2%) fistulae healed successfully with the technique of pedicled omental graft. Failure rate was 2.7%. Conclusion: Successful management of VVF largely depends upon the judicious use of omental graft with minimal recurrence rate.

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