One-stage repair for combined fistulas: myth or reality?

The repair of combined vesico-vaginal fistulas (VVFs) and recto-vaginal fistulas (RVFs) is challenging to both surgeon and patient. The multistage approach involves at least 3 surgical sessions, all associated with morbidity and sometimes with a colostomy procedure as well. The outcomes of the 1-stage approach were examined.

Twenty patients aged between 16 and 38 years were recruited for a multicenter study conducted from March 2005 to August 2006. Prolonged obstructed labor was the cause of all fistulas. The VVFs were mainly midvaginal (60%), juxtaurethral (25%), and juxtacervical (15%). The RVFs measured between 1 and 3 cm, they were low in 70% of cases, and 1 was associated with fourth-degree perineal tear. Bowel preparation was performed in all patients prior to surgery. No patient underwent temporary colostomy.

Both VVFs and VVFs were successfully closed in all patients, as evidenced by the continence dye test.

The combined repair relieves economic constraints and emotional challenges, and it accelerates restoration to health and social reintegration for women affected with both VVFs and RVFs.