[Vesico-vaginal fistula after abdominal hysterectomy. Use of the Legueu technique].
Vesicovaginal fistulas are commonly seen as a complication of abdominal (or vaginal) Hysterectomy. The signs and symptoms of a vesicovaginal fistula depend upon its size and location. Identification of a vesicovaginal fistula includes an intravenous urogram; cystoscopy may be performed in order to evaluate the possibility of immediate or delayed repair. Case report. Principles of surgical repair. The principles of surgical closure are similar: 1) total separation of the tissues comprising the wall of the vagina and the wall of the bladder; 2) sharp excision of the fistulous tract between to two structures; 3) closure of the defects with non-overlapping suture lines; 4) where possible, interposition of alternative tissue between the two suture lines. The intervention proposed by Legueu allows an abdominal transperitoneal approach to the fistula and is comprehensive of these principles. With such a procedure we have treated successfully two cases which required surgical closure. CONCLUSIONS. In patients who develop vesicovaginal fistulas as a complication of abdominal hysterectomy, we have applied the intervention proposed be Legueu, which allows closure of the fistula via a transperitoneal route. Preliminar diagnostic evaluation and following of the foundamental principles of correct surgical closure are indispensable to accomplish a successful intervention.
Vitale
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Divisione di Chirurgia Generale, USSL 30, Ospedale Maggiore di Chieri, torino.
Revelli
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G
Kiss
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A
Drago
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GW
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000379:methods; D001743:Urinary Bladder / Q000601:surgery*; D014621:Vagina / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*
Fistole vescico-vaginali dopo isterectomia addominale. Applicazione della tecnica di Legueu.