title: Surgical technique of a recurrent post-radiation vesicovaginal fistula with a small intestine graft.
abstract: Vesicovaginal fistulas are devastating conditions for the affected women. The combination of a hysterectomy and radiation increases the fistula risk 5-10 times. Radiation-induced recurrent vesicovaginal fistulas have the lowest success rate and require the most demanding treatment. We present the case of a recurrent post-radiation vesicovaginal fistula treated with a small intestine graft after unsuccessful conservative and failed previous operative treatments. The surgical management with a small intestine graft led to a permanently closed fistula. We describe the surgical abdominal procedure step-wise and review the rather scarce, post-radiation fistula literature. The closure of a vesicovaginal fistula with a small intestine graft is a complex surgical treatment with a long-term, successful result.
authors.affiliation: Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland, martin.vaso@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Vaso
authors.forename: Cornelia
authors.initials: C
authors.lastname: Betschart
authors.forename: Herwig
authors.initials: H
authors.lastname: Egger
authors.forename: Daniel
authors.initials: D
authors.lastname: Fink
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Schmidt
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small; D008875:Middle Aged; D011832:Radiation Injuries / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000150:complications / Q000601:surgery*