Correction Of Fistula Research Articles

Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery

ObjectiveThe aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate.MethodsA data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10–12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance.ResultsIn the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 – 22 years (n = 31).ConclusionsThe presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.

Pleuro-cutaneous fistula complicating chest drain insertion for melioidosis empyema

Melioidosis is a rare cause of empyema. Pleurocutaneous fistula is a pathologic communication between the pleural space and the subcutaneous tissues. Here we’re presenting a case of a Pleurocutaneous fistula complicating chest drain insertion for melioidosis empyema. Fifty-year-old fisherman from Mannar Sri Lanka presented with predominant thoracic empyema. Pleural fluid culture isolated the Burkholderia pseudomallei. A chest drain was inserted for the empyema. Subcutaneous emphysema was noted following the removal of the chest drain and it worsened over time. CECT Chest revealed the right Pleuro-cutaneous fistula, which was complicated by hemopneumothorax and trapped lung. Surgical management was refused by the patient for fistula correction and trapped lung. The fistula was successfully closed with an autologous blood patch. Melioidosis can present with predominant thoracic empyema. Pleuro-cutaneous fistula can complicate the chest drain insertion in the patient with melioidosis empyema which can be treated with an Ultrasound-guided autologous blood patch.

Urethral cutaneous fistula correction using an autologous tunica vaginalis pedicle flap in a four-year-old intact male German shepherd dog.

Urethral cutaneous fistulas are rarely reported in dogs. Several techniques have been described to treat urethrocutaneous fistulas with different degrees of success. This case report is on a four-year-old male intact German shepherd diagnosed with urethrocutaneous fistulas after two weeks of dysuria. The urethra was repaired using an autologous tunica vaginalis pedicle flap after open castration and scrotal ablation. The dog was catheterised for two weeks after which a positive contrast urethrogram revealed a healed urethra with no stricture or leakage into surrounding tissue. The dog was discharged the following day after normal urination. Follow-up examination with the referring veterinarian at five months confirmed that the dog was clinically healthy and urinating normally. Literature about urethrocutaneous fistulas is lacking in the small animal field. To our knowledge there are no reports in the literature describing the use of an autologous tunica vaginalis pedicle flap for the repair of a urethral defect in dogs. This case report describes a novel technique to treat urethrocutaneous fistulas in an intact male dog.

Surgical Correction of Recto-Umbilicus Fistula by Diverting the Rectum to the Lower Right Abdominal Wall in a Cross-Breed Calf

The congenital disability, atresia ani or atresia ani et recti or recto-vaginal fistula, is one of the most common types of congenital malformation disability. A 45-day-old male cross-breed calf was admitted to Patuakhali Science and Technology University's Veterinary Teaching Hospital with complaints of leaking feces through the umbilicus and was clinically confirmed as a recto-umbilicus fistula. This congenital condition was corrected successfully by making an artificial opening in the lower right abdominal wall. Corrective surgery was the only successful technique for repairing the recto-umbilicus fistula. The prognosis for surgical correction of the recto-umbilicus fistula in a cross-breed calf was indicated to be good.

A Rectoprostatic Fascia Reinforcement Flap for Rectal Injury and Rectoneovaginal Fistula in Gender-Affirmation Surgery.

Intraoperative rectal injuries and rectoneovaginal fistulas are rare complications in gender-affirmation surgery for trans women. Primary repair with an improper method may result in recurrence. The procedures required for the surgical treatment of these problems are rare. In this article, the authors describe the surgical technique using a rectoprostatic fascia reinforcement flap for intraoperative rectal injury and rectoneovaginal fistula correction in gender-affirmation surgery for trans women. Retrospective data were collected on the female transgender patients who underwent surgical treatment of intraoperative rectal injury and rectovaginal fistula with the prostaticovesicular fascia reinforcement flap. Patient demographics, follow-up, and intraoperative details were collected and analyzed. From January of 2006 to December of 2018, 14 female transgender patients presented with intraoperative rectal injuries and five cases of rectovaginal fistulas from a total of 2059 patients who underwent neovaginoplasty. Two patients with rectovaginal fistulas had their neovaginoplasty performed elsewhere. The mean location of intraoperative rectal injury was 5.2 cm (range, 2 to 6.5 cm), and the rectoneovaginal fistula was 5.4 cm (range, 3.5 to 6.5 cm) from the vaginal introitus. The mean size of intraoperative rectal injury and rectoneovaginal fistula was 2.5 cm (range, 1 to 3.5 cm) and 2.3 cm (range, 0.2 to 3.2 cm) in diameter, respectively. No recurrence of rectovaginal fistulas was reported after 1-year follow-up. A rectoprostatic fascia reinforcement flap is an alternative technique to repair intraoperative rectal injury and rectoneovaginal fistulas incorporating the neovaginal lining with a skin graft or sigmoid colon in gender-affirmation surgery for trans women. Therapeutic, IV.

Comparison between preoperative and postoperative depression scores among genitourinary fistula patients.

Objective: To compare depression scores in genitourinary fistula patients according to Glasgow depression scale pre and postoperatively in tertiary care hospital. Study Design: Prospective Cohort study. Setting: Inpatient and Outpatient Department of Gynecology and Obstetrics, Isra University Hospital Hyderabad. Period: December 2018 to December 2019. Material & Methods: Patients with confirmed genitourinary fistulas undergoing corrective surgery were included. Glasgow Depression scale questionnaire was filled in Gynae ward at time of admission, postoperatively at discharge (14-21 days after surgery) and at 6 months follow-up after discharge in Urogynaecological Out Patient Department. In Glasgow depression scale 20 questions were asked from patients scoring 0,1 and 2 according to answers. Those scored greater than 13 were referred to primary mental health care center and Psychologist. Results: Total of 164 patients had successful genitourinary fistula repair. The average age of women was 47.63 (SD = ±17.1) years. Mean of depression scores preoperatively, at time of discharge and after 6 months of discharge was 19.69 (SD= ±2.61), 14.90 (SD= ±2.22) and 11.34 (SD= ±2.01) respectively. Mean decrease in depression score from preoperative to six months after discharge was 8.35 units, considered statistically significant with p-value less than 0.01. Conclusion: There is significant difference in depression scores preoperatively and postoperatively. Psychological symptoms decreases after surgical correction of fistulas.

Surgical correction of fistulas in patients with cervical cancer after radiation therapy

The aim of this study was to analyze currently available information on the risks of fistulas in patients with cervical cancer after radiation therapy and possible treatment options.This review includes data from Russian and foreign articles devoted to this problem. It covers the frequency of fistulas of after radiation therapy in cervical cancer patients, as well as some treatment methods.Attempts to change the approaches to radiation therapy for advanced cervical cancer were unsuccessful; therefore, patients with cervical cancer will be at high risk of developing fistulas in the next few years. Different treatments for fistulas demonstrate contradictory results and dictate the need for a tailored-approach in such cases. The development of new surgical methods for the correction of vesicovaginal and rectovaginal fistulas is still highly relevant.

Robotic-Assisted Laparoscopy for Abdominal Cerclage and Correction of Amniotic Fistula

<h3>Study Objective</h3> To demostrate the surgical technique used for a robotic-assisted abdominal cerclage in a 13-week gravida and the closure of an amniotic fistula 4 weeks later with cyanoacrylate glue. <h3>Design</h3> Case report illustrated with video. <h3>Setting</h3> Under general anesthesia, the patient was placed in dorsolithotomy position, arms alongside the body and legs 80°abducted in adjustable stirrups. Legs were dressed under anti-embolism stockings and pneumatic compression. <h3>Patients or Participants</h3> We present the case of a 37-year-old primigravida with past medical history of adenocarcinoma of the cervix (FIGO 2018 IB2) diagnosed and treated with robotic-assisted radical trachelectomy and sentinel lymph node biopsy two years earlier. She refused hysterectomy and opted to preserve her uterus mantaining a strict follow-up due to her desire to gestate. She spontaneously got pregnant and was elegible for a robotic-assisted abdominal cerclage. <h3>Interventions</h3> The patient was scheduled for a robotic-assisted abdominal cerclage at 13 weeks. Neddled mesilane tape was placed aroud the uterine isthmus. Four weeks later, in control ultrassond, severe oligoamnium was identified and free fluid was seen in the abdominal cavity. She then underwent robotic amniotic fistula correction with cyanoacrylate glue. <h3>Measurements and Main Results</h3> Obstetric ultrasound was done before and after both surgical procedures to assess fetal vitality. The patient was discharged in the 4th day post cerclage and maintained weekly medical appointment. After the reintervention at 17 weeks, amniotic fluid was monitored and she mantains prenatal appointments. <h3>Conclusion</h3> Radical trachelectomy alone is an indication for abdominal cerclage. This patient was able to have her fertility and pregnancy preserved after an oncologycal treatment. The robotic approach in this case was useful once the extra robotic arm helped in uterus mobilization and precision of movements. The use of cyanoacrylate glue was experimental, and showed good results is restoring amniotic fluid.

PREOPERATIVE DIAGNOSIS OF THE FUNCTIONAL STATE OF THE SPHINCTER COMPLEX IN THE TREATMENT OF RECTAL FISTULAS

Abstract. Introduction. Preoperative determination of the functional state of the sphincter apparatus of the rectum is an important part of the treatment of patients. Assessment and analysis of the functional viability of the anal sphincter are necessary for the choice of tactics for surgical correction of rectal fistulas. This approach makes it possible to assess the effectiveness of a specific surgical method and determine the degree of sphincter insufficiency in the postoperative period.&#x0D; The aim of the study: to assess the normative values of neurophysiologicsl parameters of the sphincter apparatus of the rectum and pelvic floor muscles by using the method of electrosphincteromyography.&#x0D; Materials and methods. The study included 93 patients who were treated in the surgical department of the Kharkiv Regional Hospital for rectal fistulas. Indicators of the contractile function of the sphincter apparatus were determined by the method of interference electrosphincteromyography in the preoperative period. The comparison group consisted of 28 volunteers who did not have rectal diseases associated with impaired intestinal retention function (0 points on the Wexner incontinence scale).&#x0D; Results. The standard values of the bioelectrical activity of the sphincter apparatus were obtained by examining a group of volunteers by the method of interference electrosphincteromyography. The analysis of the results obtained demonstrates a slight decrease in the initial indicators of the bioelectric activity of the sphincter complex in the postoperative period.&#x0D; Conclusions. Minimally invasive methods of surgical treatment of rectal fistulas are preferred, because during the study, patients showed a decrease in the initial parameters of the contractile viability of the anal sphincter.

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment.

IntroductionGallstone Ileus is a rare complication of cholelithiasis, associated with multiple episodes of cholecystitis, with the formation of adhesions and fistulas between the gallbladder and adjacent organs. Its diagnosis is difficult, requiring complementary imaging tests such as computed tomography or radiography.Presentation of caseFemale patient, with intestinal obstruction for 7 days, associated with abdominal pain and previous episodes of pain in the right hypochondrium for 3 months. Abdominal CT scan identified aerobilia, gallstone impacted in the ileocecal valve and small loop dilatation, in addition to a probable cholecystogastric fistula. Opted for exploratory laparotomy, enterolithotomy and fistula correction in one surgical time.DiscussionGallstone ileus is rare among the complications of cholelithiasis, in addition to the fact that cholecystogastric fistula is associated with gastric pylorus obstruction and not impaction on the ileocecal valve. Imaging tests are useful to complement the diagnosis, and if Rigler's triad is present, the suspicion of gallstone ileus is increased. The presence of fistula between the gallbladder and stomach presents a frequency between 0 and 13.3%. There is no gold standard treatment for gallstone ileus, but surgery options for each type of patient and severity level.ConclusionThere is no definitive protocol for optimal surgical treatment for biliary ileus, but the possibility of enterolithotomy associated with cholecystectomy and fistula correction can be evaluated in selected patients.

When the Aorta Weakens, a Plug May Reinforce it!

A 68 year old man with a history of aortobifemoral bypass (occlusive disease), gastrectomy with Roux-en-Y reconstruction (gastric tumour) and aorto-enteric fistula correction 10 months previously by graft excision, duodenorraphy, omentoplasty, and axillobifemoral bypass presented with haematemesis. Computed tomography angiography noted a fistula between the aortic stump and the horizontal duodenal tract with contrast leakage (A, aortography, arrow). (B) Infrarenal aortic stump closure was performed using two Amplatzer Vascular Plug II (St. Jude Medical, Minnesota, USA) (arrows). The patient made an excellent recovery and refused further interventions, and remains event free at three year follow up.Image 1

MO787USE OF THE PREVENTIVE HAEMOSTASIS IN SURGICAL COMPLICATIONS OF VASCULAR ACCESS

Abstract Background and Aims Arteriovenous fistula (AVF) is currently the recommended vascular access type and its preservation is required to ensure a safe treatment for HD patients. Nevertheless, reinterventions are often needed to treat life threatening complications such as eschars, aneurysms, high flow.These surgical procedures are at high risk of bleeding, time-consuming and technically demanding. Here we describe our approach by using preventive hemostasis to treat different types of AVF complications, such as aneurysmectomy, high flow fistula correction, ulcerectomy. Method The technique consists of a few steps. First, regional anesthesia is performed by brachial plexus nerve block and intravenous antibiotic prophylactic therapy is administered. Then, an inflatable tourniquet is placed on the arm, proximally to the elbow joint, after wrapping the site with a soft gauze to prevent postoperative discomfort and bruising due to accidental pinch of the skin. The arm is then elevated to allow passive exsanguination and a 5” Esmarch bandage is applied from the hand to the tourniquet cuff. The methodical application of the Esmarch bandage requires an assistant to hold the arm properly in the upright position. Once the bandage is applied, the tourniquet is inflated to complete the exsanguination of the extremity. The inflation pressure has to be adapted to patient systolic pressure, generally a 'suitable' pressure for an upper limb tourniquet is 250-300 mmHg. Lastly, the Esmarch bandage is unwrapped and, after sterile surgical draping, it is possible to proceed to skin incision. Results From Jan 2019 to Dec 2020, we enrolled 9 patients with AVF complications treated with the preventive emostasis. The mean age of the patients was 62 years (range, 45-80 years). Table 1 shows types of AVFs and complications, performed revisions, outcomes, short and long term complications. The tourniquet average time of application was 29 + 7,7 min. Preventive hemostasis ensures absence of blood loss, even during high flow access revision. In one patient, a moderate subcutaneous hemorrhage occurred 8 hours after the end of the surgical procedure, requiring further revision. No vascular or soft tissue complications were reported except for temporary dysesthesias. Conclusion Our experience shows that preventive haemostasis offers several advantages for surgeons and patients, allowing a clear operative field and avoidance of application of clamps, prevents blood loss, and reduce the need for blood transfusion. Furthermore, reperfusion injury risk is minimized. The only complication occurred suggests the recommendation to suture skin incision after removing the tourniquet to reduce risk of postoperative bleeding. In conclusion, the technique is reliable and safely applicable to surgical treatment of vascular access complication.

Augmentation of the urethral plate in the glans penis area and the distal urethra – effective method of fistula correction in children with hypospadias

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p &lt;0.05). The decrease of urine flow according to the data of uroflowmetry was observed in 15 patients (52 %) the first group, the children of the second group did not have a decrease in the flow of urine.Discussion. The shape, size of the glans and the condition of the urethral plate affect to the result of urethroplasty. The connection of the wings of the glans in accordance with normal anatomy, avoid obstruction in the distal part of urethra. A wide urethra in the glans and meatal area improves urine flow. Conclusion. The augmentation of the urethral plate of the penile glans and the distal urethra with the implantation of a wide rectangular free flap in to the meatus, in our opinion, an advantage over the implantation of diamond-shaped grafts using the GTIP or TIP graft technique.

Long-term results of surgical correction of H-type fistula in girls with a normal anus

To evaluate the long-term results of surgical correction of H-type fistula in girls with a normal anus. There were 7 patients with rectovestibular fistula and 3 patients with rectovaginal fistula with a normal anus were observed from 2014 to 2019 in the Surgical Department No. 1 of the Russian Children's Clinical Hospital. Upon admission, all patients underwent genital examination, vaginoscopy, rectal examination and probing the fistulous canal, irrigography, abdominal and retroperitoneal ultrasound. They were also examined by a gynecologist and genital smears were obtained. Surgical treatment was determined depending on the height and diameter of the fistula for each child. One patient underwent perineal fistulectomy, three patients - anterior anorectoplasty. Invaginated fistula extirpation, abdominoperineal proctoplasty and perineal fistulectomy using a pad flap between the defects were used in two cases, respectively. Patients were followed-up for the period from 6 months to 1 year after the last recurrence. Follow-up examination, irrigography and functional examination of sphincter were performed. Two (20%) patients did not require redo surgery. In 6 (60%) cases, recurrences didn't occur within a year after the second surgery, in 2 (20%) cases - after 3 operations. Recurrent H-type fistula appeared after 3 of 4 perineal fistulectomy procedures, 3 of 9 anterior anorectoplasty, 2 of 2 abdominoperineal proctoplasty and 2 of 3 invaginated fistula extirpation. Hypotension of internal anal sphincter and neo-rectal ampulla, recurrent vulvovaginitis were diagnosed in 2 patients in 6 months after anterior anorectoplasty. We recommend anterior anorectoplasty and perineal fistulectomy using a pad flap between the defects for the treatment of H-type fistula to minimize the risk of recurrence.

PRIMARY PROCEDURE FOR RECTO-VESTIBULAR FISTULA IN FEMALE CHILDREN: AN EARLY EXPERIENCE AT KHYBER TEACHING HOSPITAL PESHAWAR.

Abstract &#x0D; Background: Recto-vestibular fistula is the most common variant of Anorectal malformation in female children. Traditional management of this entity is a three stages procedure i.e. colostomy, PSARP, and colostomy closure. The aim of this study was to manage these patients by a primary definitive surgical procedure without colostomy and to know the procedure feasibility, cost effectiveness, complications, safety and short term functional outcome.&#x0D; Materials and method: &#x0D; Results: A total of 40 female children fulfilling inclusion criteria of the study were included. Age range was 28 days to 8 months. No mortality noted during study period. Mean operative time was 50±15 minutes. Mean Hospital stay in days was 6.65.Procedure related complications were recorded as wound infection 5(12.5%), wound dehiscence 1 (2.5%), posterior vaginal wall injury 5(12.5%).Overall parental satisfaction regarding procedure was 92.5%.&#x0D; Conclusion: Primary single stage procedure either by PSARP or ASARP for the correction of Rectovestibular fistula in female children of ARM was less traumatic to children, acceptable to their parents, having cost effectiveness for poor socioeconomic parents and encouraging functional outcome.&#x0D;

Surgical Outcomes of Transvaginal Neobladder-Vaginal Fistula Repair After Radical Cystectomy with Ileal Orthotopic Neobladder: A Case-Control Study.

PurposeTo present surgical methods and outcomes in women with bladder cancer (BCa) requiring correction of neobladder-vaginal fistula (NVF) after radical cystectomy (RC) with ileal orthotopic neobladder (IONB).Materials and MethodsThe medical records of 163 women who underwent RC with IONB for BCa between January 2010 and December 2018 were retrospectively reviewed. The presence of NVF was confirmed by cystoscopy and/or voiding cystography. NVF repair was performed using a transvaginal approach, which included circumferential incision of the fistula tract, creation of a plane between the neobladder serosa and the vaginal epithelium, and multi-layered transvaginal closure.ResultsDuring a median follow-up of 47.9 months, NVF was identified in 12 (8.8%) of the 163 included women. Eight (66.7%) fistulas were located in the proximal anterior vaginal wall and four (33.3%) in the vaginal apex. Median time from RC to NVF repair was 3.4 months (range, 2.1–5.6 months), median NVF size was 6.0 mm (range, 4.0–22.0 mm), and median duration of urethral Foley catheter indwelling was 24.0 days (range, 15.0–43.0 days). Initial repair of NVF was successful in ten (83.3%) patients. Two (16.7%) patients who relapsed retained IONB through the subsequent operation. Two (16.7%) patients developed severe urinary incontinence after NVF repair, requiring anti-incontinence surgery with a synthetic transobturator mid-urethral sling.ConclusionThe transvaginal approach for NVF repair is feasible, yielding successful surgical outcomes. However, women should be counseled about the risks of relapse and urinary incontinence.

Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases

Purpose: Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. Methods: Retrospective observational study included 36 cases of open VVF repair, performed during 2010–2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O’Conor was performed and doubly folded peritoneal flap was utilized. Intra- and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of follow-up was done. Results: Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. Conclusion: Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.

Psychological wellbeing of women after surgical correction of obstetric fistula in Northwest Ethiopia: a pre-post design

ABSTRACT The physical problems associated with fistula result in psychological alteration. This study was aimed to assess whether psychological wellbeing of women with fistula after surgical treatment differ from that of before treatment. Institution-based pre-post follow-up design was conducted. Self-reported incontinence and psychological wellbeing score were assessed. Data were analyzed using Stata 12. Paired t-test and multiple linear regressions were fitted to identify variables correlate with the score difference. In this study, 117 women were interviewed giving response rate of 98.3 percent. Their mean (±sd) age was 27.13 ± 5.37 years. On admission, all women had urinary or fecal incontinence and their mean psychological score was 31.1 (95 percent CI; 30.5–31.6). After treatment, however, 89.7 percent (n = 105) of women reported that they regained continence. Similarly, the mean psychological score has dropped to 18.05 (95 percent CI; 16.4–21.6, p < .001). Pre-treatment score, normal body weight, regaining continence, and getting counseling service were correlates of score difference. Psychological wellbeing of women with genital fistula was improved drastically after treatment. Establishing a system for early identification and treatment of cases could reduce prolonged psychological alteration.

Tube-like preputial mucosa urethrostomy for correction of urethrorectal fistula in a young male cat

A 10-month-old cat exhibited simultaneously penile urethra obstruction and rectourethral fistula. The pubic osteotomy was a method to approach the fistula to locate the pelvic urethra opening into the rectum. Surgical correction consisted of ligation and cutting of the urethra connecting to the rectum, and a primary suture to connect the urethra to prepuce for a new opening. The tomcat catheter was placed in the urethra for a ten days-period. Ten days after the surgery, the cat was transferred to have urethrography to examine the lumen of the defective urethra, and the result showed no sign of urine leakage and stricture. After the catheter removal, the cat could urinate normally, and there was no sign of complications during urination, and no urine coming from the rectum found. In brief, this case report describes a successful urethral reconstruction for repairing the urethrorectal fistula by primary suture connecting the urethra with prepuce mucosa.

The outcome of two stage repair in anorectal malformations with rectovestibular fistula.

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material &amp; Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.