Omentoplasty for complex fistulas
From the upper middle or laparoscopic approach, the surgeon dissects the vesico-vaginal septum down to the fistula (O'Conor's operation), excises the scars, sutures the vagina and bladder in several layers and places a well-supplied pedunculated omentum flap between them - this is critical for radiation and repeated fistulas, where the own tissues do not heal well. If the ureter is damaged, its reimplantation is simultaneously performed. The catheter and drains last 10–14 days. Success with primary complex fistulas is 90%, with radial fistulas - 70–85%.
Genitourinary fistulas
A fistula is a pathological connection between the urinary tract and the vagina, intestines or skin, in which urine constantly leaks. Causes: damage to the bladder during gynecological operations (cesarean section, hysterectomy), prolonged labor, radiation therapy, common tumors, trauma; renal-intestinal fistulas are a consequence of purulent processes and kidney tumors. The fistulas do not close on their own (except for very small ones when the bladder is drained); treatment is surgical plastic surgery with separate suturing of the organs and laying tissue between them.
Select access
Transvaginal fistulorrhaphy - for low vesicovaginal fistulas, low-traumatic; transvesical (through an open bladder) and transabdominal - for high, complex, multiple fistulas, involvement of the ureters and after radiation therapy. The first operation gives 90-95% success, so it is important to perform it in a specialized center and at the right time (2-3 months after injury, with radiation - 6-12 months).
