Related Experiment Videos
Fistula formation after implanting an ePTFE membrane. A case report
C A Monteforte1, R Queirazza, P Franceschetti
1Division of Obstetrics and Gynecology, Ospedale Civile di Vigevano, Pavia, Italy.
The Journal of Reproductive Medicine
|March 1, 1997
Summary
Expanded polytetrafluoroethylene (ePTFE) membranes can cause bladder fistulas after myomectomy. Surgeons should consider removing ePTFE implants after healing in anterior uterine incision cases to prevent complications.
Area of Science:
- Gynecologic surgery
- Surgical implant materials
- Adhesion prevention
Background:
- Expanded polytetrafluoroethylene (ePTFE) membranes are utilized as permanent implants to prevent adhesions post-gynecologic surgery.
- Fistulization associated with ePTFE implants has not been previously documented.
Observation:
- A 27-year-old female presented with pain and micturition issues four years post-myomectomy with ePTFE membrane implantation.
- Laparotomy revealed partial insertion of the ePTFE membrane into the anterior bladder wall near the vesicouterine pouch.
- Pathological examination of the removed membrane showed multispecies bacterial contamination.
Findings:
- The fistula likely resulted from ischemia at the vesicouterine fold, potentially caused by membrane suturing, leading to prosthesis intussusception.
- The created hole enlarged, and pelvic inflammatory disease likely contributed to local sepsis.
- ePTFE membranes are effective adhesion barriers for posterior/fundal uterine incisions during myomectomy.
Implications:
- For anterior uterine incisions in myomectomy, surgeons should consider removing ePTFE membranes post-peritoneal healing to mitigate fistula risk.
- This case highlights a rare but serious complication of ePTFE membrane use in specific surgical scenarios.
- Careful consideration of implant placement and removal timing is crucial in gynecologic surgery involving adhesion barriers.