title: Supratrigonal VVF repair by modified O'Connor's technique: an experience of 26 cases.
abstract: OBJECTIVE
  To report the technical modifications of O'Connor's procedure and their outcome in 26 supratrigonal vesico vaginal fistulae.
  
  
  METHODS
  Twenty-six cases of supratrigonal VVF (17 primary, 9 recurrent) were operated using the described modifications. It consisted of approaching the bladder transperitoneally, without dissecting the retropubic space, making a short sagittal or parasagittal cystotomy in between stay sutures, liberal use of bladder rotation flaps instead of midline closure, using single layer, continuous, closely placed, interlocking stitches for bladder as well as vaginal approximation and universal use of vascularised tissue interposition.
  
  
  RESULTS
  Mean fistula size was 2.8 cm (range 1.0 to 3.7). Mean operative time was 104 minutes, and blood loss was insignificant. Three patients required ureteroneocystostomy. All patients were dry after 2-3 weeks of suprapubic and per urethral catheter drainage. One patient persisted with stress urinary incontinence. No patient on follow up complained of features suggestive of prolonged ileus, peritonitis or adhesive intestinal obstruction.
  
  
  CONCLUSIONS
  Modified O'Connor's repair is safe and achieves excellent functional results. It requires a shorter cystotomy instead of bi-valving of the bladder, thus minimizes tissue trauma, intraoperative blood loss and operating time. It also gives option of tailoring the cystotomy in sagittal or parasagittal line, according to the site and size of the fistula, and thus permits closure of fistula by rotation of bladder flap into the defect without any lateral traction on the bladder edges. Retropubic dissection and drainage of the retropubic space is also not required.
authors.affiliation: Department of Urology, King George Medical University, Lucknow, UP, India.
authors.forename: Divakar
authors.initials: D
authors.lastname: Dalela
authors.forename: Priyadarshi
authors.initials: P
authors.lastname: Ranjan
authors.forename: Pushpa Lata
authors.initials: PL
authors.lastname: Sankhwar
authors.forename: Satya N
authors.initials: SN
authors.lastname: Sankhwar
authors.forename: Vineet
authors.initials: V
authors.lastname: Naja
authors.forename: Apul
authors.initials: A
authors.lastname: Goel
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D013524:Surgical Flaps; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*