vesicovaginal fistula repair

Indication Applicable to most vaginal vagina, especially those with lower sacral tract. Preoperative preparation Clean the vagina and use intestinal antibiotics 3 days before surgery. Surgical procedure There are two procedures for transvaginal repair. The excision-separation method is suitable for pupils of various sizes and is most commonly used. 1. Position and disinfection take the lithotomy position, those who have difficulty in exposure may take the prone position. Routine disinfection of the vulva and vagina. 2. Exposure surgery to fix the labia minora on the outer skin of the labia majora, expose the pupil with a vaginal hook, use the cervical forceps to pull the cervix, and use a metal catheter to probe the pupil to understand its size, location, number and presence or absence of scar. . 3. The incision is under the urethral opening, and the anterior wall of the vagina is cut along the midline. The depth of the incision is not more than the degree of the mucosa (about 0.3 cm). Make an annular incision along the edge of the pupil and extend up and down along the midline of the anterior wall of the vagina. 4. Separate the vaginal wall and separate the gap between the vaginal wall and the bladder wall along the incision. The separation width is about 2 cm, and the vaginal wall is pulled to expose the pupil and the bladder wall. 5. The edge of the pupil is generally not required to be trimmed, because the pupil becomes larger after trimming, and the suture tension is increased. However, if the organization has surplus and the scar is hard and many, it can be properly trimmed. 6. The sutured pupil is divided into three layers of suture, namely two layers of the bladder wall and one layer of the vaginal wall. (1) The first layer of suture is a transverse suture-type suture with reduced tension, and the needle pitch is about 0.5 cm. Only the muscles and fascia are sewed without passing through the bladder mucosa to avoid postoperative suture stones. (2) The second layer of suture is still sutured with intermittent suture. The suture is about 0.5 cm from the first layer, and the needle should be staggered from the first layer. (3) The third layer of suture interrupted the vaginal wall. The suture direction may be perpendicular or parallel to the direction of the suture of the bladder, and the tension is preferably small. If the vaginal mucosa is too strong, it can be opened without suturing. 7. After the second layer of suture is completed, the bladder is injected into the bladder with a dilution of 60-100 ml of methylene blue, so that the pressure is slow to prevent the liquid from leaking out. If there is any leakage, add a needle at the corresponding position. 8. Vaginal built-in gauze surgery to retain the catheter, vaginal gauze. If there is more intraoperative bleeding, the bladder should be rinsed with sterile saline at the end of the operation. High vaginal closure is mainly used for high vaginal fistula of the vaginal stump after hysterectomy. 1. Excision of the vaginal mucosa around the pupil about 1 ~ 2cm from the edge of the pupil, circular incision of the vaginal mucosa, peeling off the mucosa around the pupil to the temporal margin. 2. Stitching the anterior and posterior wall of the vagina will suture the anterior and posterior wall of the vagina, sometimes requiring a layer of reinforcement. complication 1. Tissue suture tension greatly reduces the tension when suturing the pupil, and the bladder wall of the temporal region must be separated to make the incision margin loose. However, excessive separation of the bladder wall tissue will affect blood supply, resulting in poor healing of the suture. Generally, the bladder wall is double-stitched, and if the tension of the double-layer suture is too large, a layer can be sewn. In addition, the vaginal wall mucosal suture incision line can be perpendicular to the suture of the bladder to reduce tension. 2. In addition to the reduction of the sacral varus suture, the suture needle spacing of the sputum should not be too dense, and the suture can not be pulled too tight.