In our clinical observations, the indications for the closure of vesico-vaginal fistula, transvesical access with the use of a flap of peritoneum was high recurrent, long-existing fistula when razvlekaelnye access anatomically cannot perform the operation, and multiple scar tissue does not allow to hope for a full regeneration.
This access is used and when the mouth of the ureter was located in the vicinity of fistulous openings or were directly involved in the scarring process in violation of the functions of the corresponding kidney.
Our method of plastic surgery because of vesico-vaginal fistula Rasputina method using a flap of peritoneum is as follows. After opening the bladder suprapubic access and visual detection of the fistula, the mobilization of the posterior wall of the bladder with simultaneous detachment from the vaginal walls and wide excision of scar-modified tissue around the fistula.
Cut out the required length and width of 1-2 cm rectangular flap of peritoneum that covers the top of the bladder. The free edge of the flap of peritoneum is fixed at 1 cm distal to the lower edge of the fistula to the rear wall area of the bladder and sutured fistula bladder separate catgut sutures, superimposed on his wall with a simultaneous catch up to them flap of peritoneum.
This creates additional peritoneale former cystic defect that improves sealing and regeneration. Then sutured to the vaginal wall and the peritoneal defect in the zone of the apex of the bladder. The operation ends with the drainage of the bladder and pericystic space.
To create better drainage of urine from the bladder, we use the method of active aspiration using a vacuum suction.
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