Postpartum VVF is best repaired after:
Correct Answer: 3 months
Description: Management of VVF is surgical management:
The timing of surgery -
Small urinary fistulas sometimes heal spontaneously during the first few weeks.
However, in a case of established fistula - it is better to wait for about 3 months° for all tissue inflammation to subside. If one attempt fails to heal fistula, the second attempt is done after 3 months.°
In fistulas following surgery, waiting period is 3-6 months.
In fistulas following radiation: 6 months - 2 years time can be taken before inflammation subsides.
Techniques of Repair -
Layer technique
Latzko procedure (for fistulas following hysterectomy)
Chassar Moir technique.
Post-operative Management -
Continuous bladder drainage for 14 days.
Antibiotic coverage.
No vaginal examination, P/S, intercourse x 3 months.
Avoid pregnancy for 2 years.
In pregnancy after repair of vaginal fistula - elective cesarean is done.
Extra Edge:
This question is an old one so here answer will be 3 months but if this question is repeated now remember the following lines from Williams Gynae. 1st /ed 575-576:
"Timing of repair: Traditional teaching recommends delayed repair of fistulas at 3 - 6 months after injury. However, this old dictum is probably no longer applicable. Most agree that unless there is a severe infection or acute signs of inflammation, waiting is not necessary. Early surgical intervention of uncomplicated fistulas does not affect closure rates, yet appears to reduce social and psychological patient distress (Balivas, 1995). Fistulas identified within the first 24 - 48 hours postoperatively can be safely repaired immediately with success rates of 90 - 100%."
Category:
Gynaecology & Obstetrics
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