Fistula Repair Research Articles

Introduction/Background: Sinus of Valsalva aneurysms are very rare congenital heart disease. Most cases of ruptured sinus of Valsalva aneurysms (RSVA) are associated with other congenital defects. We present a case of Sinus of valsalva aneurysm (SoVA) rupture with underlying supracristal VSD (sVSD). Case Presentation: A 27-year-old male with a past medical history significant for a VSD (diagnosed at childhood but lost to follow up at 18 years of age) who was admitted to the intensive care unit for management of undifferentiated shock, acute renal failure and acute liver failure. Upon initial evaluation, vital signs showed blood pressure of 130/34 mmHg, heart rate 118 bpm, SpO2 100% on 3L NC. An emergent transthoracic echocardiogram with color doppler showed unrestricted left to right flow from the RSoV to RVOT in systole and diastole with concern for ruptured SoV aneurysm. A non-contrast CT scan of the chest also showed a dilated pulmonary trunk with a connection between the SoV and RVOT. Patient underwent primary closure of the VSD, as well as a patch repair of a large fistula between R sinus of Valsalva and RVOT. Patient steadily improved with normalization of renal function and hepatic function. Discussion: Aneurysm of the sinus of Valsalva (SoV) is a rare acquired or congenital anomaly predominantly affecting the right and the noncoronary sinuses, with an estimated prevalence of 0.09% of the population. Most sinus of Valsalva aneurysms arise from the right or the noncoronary sinuses. The most common site of rupture of SOV aneurysm is into the right ventricle followed by right atrium, left ventricle, and the left atrium. Hemodynamically, the flow through VSD produces Venturi effect “windsock effect. This left to right shunt caused by the supracristal VSD weakens the elastic lamina of the aortic sinus creating the SOV aneurysm. Overtime due to continuous negative pressure a SOVA develops on the right aortic root, which can rupture into the right ventricular outflow tract as seen in our case. Conclusion: Sinus of Valsalva aneurysm rupture is a rare but potentially fatal complication and should be considered on the differential in a young individual with underlying sVSD presenting with hemodynamic collapse.

Nationwide Propensity-Matched Analysis of Robotic Vs. Non-Robotic Repair of Rectovaginal and Colovaginal Fistulas

Management of Complex Aortic Endograft Infection by a Multidisciplinary Team.

This study retrospectively reviewed genitourinary fistula (GUF) cases repaired at a leading tertiary care center in northern India, analyzing surgical outcomes. The study was conducted in the Department of Urology at King George's Medical University, Lucknow, from 2000 to 2024. This study obtained ethical approval from the institutional committee. Data were collected from hospital records, telephonic communication, and digital media. Obstetric and gynecologic histories, examination findings, cystoscopy, vaginoscopy results (including site, size, number of fistulae, and vaginal status), and imaging findings were documented. Operative details of open transabdominal (TA), transvaginal (TV), and laparoscopic repairs, along with surgical success rate and follow-up, were analyzed. A total of 638 GUF cases were repaired over a 25-year period. Vesicovaginal fistula (VVF) was the most common (572 cases, 89.65%), followed by ureterovaginal fistula (44 cases, 46 units, 6.89%), and urethrovaginal fistula (UVF) (12 cases, 1.88%). Hysterectomy was the leading cause (431 cases), followed by obstetric causes (175 cases), traumatic (12), radiation (5), and other causes (15). Surgical techniques included open TA (309 cases), TV (213), and laparoscopic repairs (116). The surgical success rate (cure of urinary incontinence with complete restoration of bladder and vaginal functions at 3 months) following first repairs was 93.95% (TA), 94.24% (TV), and 96.55% (laparoscopic). The surgical success rate following the second repair at 3 months was 82.05% (TA) and 82.75% (TV). No repeat laparoscopic repairs were performed. The overall success rates (combined first and second repair) were 95.78% (TA) and 95.77% (TV). The overall mean follow-up was 48 months (ranging from 3 to 120 months). Over 25 years, our single-center experience reveals a shift from obstetric to gynecologic causes of genitourinary fistulas, with hysterectomy emerging as the leading etiology. Surgical repairs via TA, TV, and laparoscopic approaches showed high success rates. A clear trend toward minimally invasive techniques was observed, reflecting advancements in surgical practice.

Background: The perioperative management of neonates with esophageal atresia and Type C tracheoesophageal fistula (EA/TEF) is exceptionally challenging, particularly in cases of delayed diagnosis complicated by aspiration pneumonia and congenital heart disease. The primary anesthetic risk is catastrophic gastric insufflation and hemodynamic collapse from positive pressure ventilation (PPV) before fistula control. This report details a successful multidisciplinary strategy centered on an airway technique that preserves spontaneous ventilation. Case presentation: A 16-day-old, 2.5 kg female neonate with Type C EA/TEF presented for surgical repair following a delayed referral. The case was critically complicated by severe aspiration pneumonia (cultures positive for Klebsiella pneumoniae), which was managed with targeted antibiotic therapy, and hemodynamically significant congenital heart defects (2.5 mm patent ductus arteriosus, 3 mm patent foramen ovale). After 48 hours of intensive cardiorespiratory and nutritional optimization in the neonatal intensive care unit (NICU), the patient underwent surgery. To circumvent the life-threatening risks of PPV, an inhalational induction with sevoflurane was performed, maintaining spontaneous ventilation. The airway was secured via direct laryngoscopy without neuromuscular blockade. A right extrapleural thoracotomy, fistula ligation, and primary esophageal anastomosis were successfully performed. Intraoperative lung retraction-induced desaturation was managed with coordinated surgeon-anesthetist maneuvers. The postoperative course was uneventful. Conclusion: In a high-risk neonate with delayed TEF presentation and profound cardiorespiratory compromise, securing the airway while maintaining spontaneous ventilation is a cornerstone of safe anesthetic practice. This approach, integrated within a comprehensive, multidisciplinary management plan, directly mitigates the risk of gastric perforation and cardiovascular collapse, thereby enabling a successful surgical repair and favorable outcome.

Background and Objectives: Intraoperative bleeding during neurosurgical procedures poses a significant risk by increasing morbidity and mortality, obscuring the surgical field and prolonging operative time and hospitalization. Effective hemostasis is therefore essential, frequently necessitating the use of topical hemostatic agents. This study aimed to evaluate the performance of a plant-derived oxidized regenerated cellulose (ORC) hemostatic agent StypCel™ Absorbable Hemostat (Medprin Regenerative Medical Technologies Co., Ltd.) in various neurosurgical interventions, including intracranial tumor resections, spinal surgeries, trigeminal neuralgia operations, cerebrospinal fluid fistula repair and ventriculoperitoneal shunt implantation. The study aimed to assess its performance in these procedures due to the high risk of intraoperative bleeding and the challenges of achieving hemostasis in delicate neural structures. Materials and Methods: This prospective, single-arm clinical study included 46 patients who underwent neurosurgical procedures at three neurosurgerical clinics in Riga, Latvia. The primary endpoint was the rate of effective bleeding control achieved within 5 min of StypCel™ application. Safety assessments included monitoring for central nervous system infections (CNSI), intracranial granuloma formation, new-onset neurological deficits, seizures, anaphylactic reactions or device malfunction. All adverse events (AEs) and serious adverse events (SAEs) were documented during the postoperative follow-up. Results: The cohort consisted of 46 patients (29 females and 17 males), including 20 with neoplastic intracranial lesions and 26 with other neurosurgical pathologies. Effective bleeding control within 5 min was achieved in 93.5% of cases (95% CI: 82.1–98.6%). In three patients, bleeding control exceeded 5 min due to unexpected arterial hemorrhage encountered during intracranial tumor resection. No device-related AEs, SAEs, CNSIs or granuloma formations were reported throughout the follow-up period. Conclusions: The findings demonstrate that StypCel™ Absorbable Hemostat is a safe and effective adjunct for achieving intraoperative hemostasis in neurosurgical procedures. Its favorable safety profile and high hemostatic success rate support its clinical utility, particularly for controlling low-pressure venous or capillary bleeding. Further comparative and long-term studies are warranted to validate these results in broader surgical settings.

ObjectiveThe objective of this study was to systematically analyze the cleft lip and/or palate (CL/P) literature published between 2000 and 2025 to identify dominant research themes, temporal trends, and potential gaps by applying a natural language processing-based topic modeling approach.DesignWe analyzed articles retrieved from the Scopus database and identified thematic clusters using the BERTopic algorithm, which integrates BERT embeddings, Uniform Manifold Approximation and Projection dimensionality reduction, and Hierarchical Density-Based Spatial Clustering of Applications with Noise clustering.SettingThis study exclusively examined articles related to CL/P.Patients/ParticipantsThis study involved no patients or participants.InterventionsNot applicable as this is a BERTopic-based analysis.Main Outcome MeasuresOutcomes included identifying dominant research topics, trend analysis, distribution across countries and journals, and classifying topics as "hot" or "cold" based on temporal trends.ResultsWe identified 29 thematic clusters. The most common topics included "Velopharyngeal Dysfunction and Fistula Repair," "Nonsyndromic Cleft Lip and Palate and Genetic Associations," and "Unilateral Cleft Lip and Palate and Maxillofacial Asymmetry." "Quality of Life and Psychosocial Impact in Children," "Surgical Repair Approaches," and "Presurgical Nasoalveolar Molding Techniques" emerged as "hot topics." The United States led in publication volume, while certain topics dominated in specific countries. The Cleft Palate-Craniofacial Journal published the most articles.ConclusionsThis study provides a comprehensive thematic map of CL/P research, highlighting strengths and underexplored areas. BERTopic offers an efficient, scalable method for analyzing large-scale scientific literature and identifying future research priorities.

This video illustrates the surgical repair of a vesicouterine fistula (VUF) via a transperitoneal, robot-assisted, uterus-sparing approach. In this video, we present a VUF that occurred after a cesarean section. The patient presented 22years later with persistent hematuria. She underwent a uterus-sparing, robot-assisted repair via excision of the fistula tract. The uterus and bladder were closed in multiple layers with omental interposition. The patient tolerated the procedure well. A follow-up cystography confirmed the absence of defects or fistula recurrence. She has remained asymptomatic since the surgery. Our video demonstrates the feasibility of vesicouterine fistula repair with uterine preservation using an exclusively robot-assisted transperitoneal approach with omental interposition, yielding excellent results.

Introduction. Anal fistulas (AF) can be both an independent source of infection and the cause of perianal abscess recurrence. The use of sphincter-preserving plastic surgical methods for the elimination of AF in patients with hematologic malignancies is an insufficiently studied issue. Aim: To demonstrate the possibility of using plastic surgical methods for the elimination of rectovaginal and anal fistulas in hematological patients. Materials and methods . Between 2022 and 2024, 5 patients aged 36 to 56 years were operated on for complex anal and rectovaginal fistulas; of these, 3 patients had acute myeloblastic leukemia (AML), 1 had non-Hodgkin’s lymphoma, and one patient had immune thrombocytopenia. In one case, elimination of a rectovaginal fistula was performed using a split vaginal-rectal flap; in the rest — the anal fistulas were eliminated using a displaced lateral flap. The follow-up period ranged from 8 to 28 months. Results. Elimination of the AF was achieved in 4 out of 5 patients. On the 2nd day after surgery, 1 patient developed thrombosis of hemorrhoids in the area of the displaced flap, and on the 10th day, a recurrence of the fistula was detected. Signs of 1st degree anal insufficiency were diagnosed in two patients who had previously undergone anal surgery. Treatment for hematologic malignancies was continued after surgery for two patients, one of whom underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), while the other underwent induction of a second remission due to a AML relapse. Conclusion. Given the minimal surgical trauma and low complication rate, fistula repair using displaced flaps can be used in hematological patients. If rehabilitation timelines are observed, it is possible to resume antitumor therapy, including performing allo-HSCT.

Minimizing the complications of open repair of aortocaval fistula using cardiopulmonary bypass: A case report

Novel technique for the repair of recurrent oronasal fistula using autologous auricular composite graft: Clinical outcomes from a case series

Surgical repair of post-radical prostatectomy rectovesical fistula with gracilis flap

Palatal fistulae remain one of the most challenging complications following cleft palate repair, with incidence rates reported between 2.4% and 35% in recent studies. They pose significant morbidity for patients, including oronasal regurgitation, speech impairment, and failure to thrive. Although extensively studied in pediatric populations, palatal fistula repair in adults remains poorly documented. Adult patients frequently present with more chronic defects, extensive fibrosis, and reduced tissue elasticity, necessitating a tailored surgical approach. This study aimed to evaluate the surgical management of adult palatal fistulas at a high-volume cleft center, highlighting the challenges and complexities associated with repair, as well as recurrence rates. A retrospective cohort study was conducted at CLAPP Hospital, Lahore, Pakistan, including adult patients 18 years and older who presented with palatal fistulas between January 2015 and December 2023. Patient demographics, fistula size and location, surgical techniques utilized, recurrence rates, and associated risk factors were collected and analyzed. Surgical techniques included Bardach redo-palatoplasty, Langenbeck redo-palatoplasty, buccal sulcus flap, buccinator flap, and tongue flap, contralateral mucoperiosteal flap, among others. Statistical analysis was performed using R (Version 4.3.2). A total of 231 patients (mean age, 24.7 ± 6.07 years) were included. Most fistulas were located in the anterior (29.9%) and posterior (10.4%) hard palate, with a significant proportion (32.5%) extending across multiple midline regions. Fistula sizes varied, with 18.6% classified as S3 (11-15 mm) and 21.6% as S4 (>15 mm). The most commonly utilized technique was Bardach redo-palatoplasty (60.6%), followed by buccal sulcus flap (11.7%). Overall, 21.2% of patients experienced fistula recurrence, with significantly higher recurrence rates in patients with previously repaired fistulas (P = 0.0209). Univariate and multivariate analyses identified fistulas exceeding more than 15 mm (P = 0.008) and lateral fistulas as having the highest risk of recurrence (P = 0.021). Despite the inherent challenges, palatal fistula repair in adults yields significant improvements in functional outcomes and quality of life. A tailored surgical approach, meticulous planning, and adequate surgical expertise remain essential to achieving optimal outcomes.

Transperineal approach for the repair of a low H-type rectovestibular fistula: a case report

Endoscopic posterior cricoid split with costal cartilage graft in pediatric bilateral vocal cord paralysis: A retrospective institutional series and literature comparison.

Transvaginal apical vesicovaginal fistula repair: Anatomical basis for direct transvaginal surgery, vaginal natural orifice transluminal endoscopic surgery (V-NOTES) including single-port robotic assisted surgery

ObjectiveTo assess the relationship between neighborhood-level social disadvantage, as measured by Area Deprivation Index (ADI) and Childhood Opportunity Index (COI), and postoperative outcomes and follow-up care after primary or secondary cleft palate repair.DesignRetrospective cohort study.SettingAcademic tertiary care center.PatientsPediatric patients with cleft palate with or without cleft lip (CP ± L).InterventionsPrimary palatoplasty, revision palatoplasty, or closure of oronasal fistula.Main outcome measuresPostoperative complications and clinic follow-up adherence.ResultsA total of 244 patients were included in the study. Among all patients, there was only a moderate correlation between patients' ADI and COI quintiles (R2 = 0.465, P < .001). In patients undergoing primary palatoplasty, greater ADI neighborhood deprivation was significantly associated with a greater number of no-show (P = .011) and cancelled (P = .025) clinic appointments. In patients undergoing revision palatoplasty, greater ADI neighborhood deprivation was significantly associated with higher rates of postoperative complications (P = .016) and a greater number of no-show clinic appointments (P = .036). Greater COI disadvantage was associated with significantly higher rates of hospital readmission (P = .049) and fewer cancelled clinic appointments (P = .049) in revision palatoplasties. Neighborhood disadvantage was not predictive of any oronasal fistula repair postoperative outcomes, follow-up adherence, or patient characteristics at surgery.ConclusionsNeighborhood-level social disadvantage indices are predictive of suboptimal surgical outcomes and follow-up adherence in patients undergoing cleft palate surgery and could be used to identify patients who may benefit from additional clinic outreach and support.

Optimizing palatal fistula repair: CLAPP Hospital's institutional experience tracking success and recurrence in 510 cases over 3 years.

AimThis study was carried out to evaluate a rectal pull-back one-stage technique, which is a modification of the one-stage Goetz technique, for treating third-degree perineal laceration or rectovestibular fistula.Materials and methodsThis study was performed on 12 mares, ten of whom suffered from third-grade perineal laceration, and two suffered from rectovestibular fistula and were included in this study. After incision of the vestibular shelf horizontally, the dissected rectal flap was pulled caudally and sutured to the anal sphincter during its reconstruction at the final stage. While the vestibular shelf/vaginal flap was reconstructed using size 2 polyglactin 910 suture material in six-bite suture pattern. Post-oparative follow up included monitoring the wound healing and recording the complications. ResultsNeither necrosis of the rectovestibular shelf nor formation of rectovestibular fistula has been recorded. Two mares showed partial dehiscence of the perineal body and one had partial dehiscence of anal sphincter which healed successfully.ConclusionRectal pull-back technique can be a good alternative for the treatment of third-grade perineal laceration and rectovestibular fistula in mares.

We report a case of a 77-year-old woman with an aneurysmal coronary-pulmonary artery fistula, which was incidentally identified on contrast-enhanced computed tomography. To prevent rupture and other potential complications, surgical repair was indicated. The procedure was performed via bilateral minithoracotomy, providing sufficient exposure while minimizing invasiveness. The aneurysmal segment was successfully excluded without intra-operative complications. Post-operative contrast-enhanced computed tomography confirmed complete exclusion of the lesion with no residual opacification. The patient's recovery was uneventful. This video tutorial demonstrates the step-by-step surgical technique used in this case, highlighting key considerations in exposure, fistula identification and closure. A bilateral minimally invasive approach may be a safe and effective option for selected patients with aneurysmal coronary-pulmonary artery fistulae, especially when conventional sternotomy is not desirable. This case adds to the limited literature on minimally invasive treatment of this rare condition and may assist surgeons in planning similar procedures.