[Surgical management of obstetric fistulae]

With three decades of experience in the treatment of obstetric fistulae (OF), the authors discuss surgical management of OF secondary to blocked labor (> 48 hours), the main cause of OF in poor countries. Clinical classification is mandatory to ensure the correct indication, with three situations of increasing difficulty. The technical principles are simple and few instruments are required. Surgical difficulty increases in case of tissue sclerosis, difficult locations, and associated lesions (sphincter destruction, recto-anal fistulae, etc.). Group I OF can be cured in a single operation, while complex OF require two or more surgical procedures for cure or improvement. Better post-surgical care and more clinical and surgical research are needed to improve these women's outcomes. Despite some progress in the last decade, the situation in poor countries remains unacceptable. Prevention is clearly possible, through emergency obstetric care and better obstetric skills, as this dramatic complication of dystocia has virtually disappeared in rich countries.