(7) The bladder is distended with distilled sterile water to determine any
leaks. A catheter is left in the bladder; dressing are applied and held in place with a
nonirritating plastic tape and a binder.
c. Operative Procedure--Trans-peritoneal Approach.
(1) With the patient in a slight Trendelenburg position, a median abdominal
incision is made, as for laparotomy.
(2) The fistulous tract is identified; the vaginal vault and the adjacent
adherent bladder are separated with scissors, forceps, and sponges.
(3) The vesicovaginal septum is dissected down to the healthy tissue
beyond the site of the fistula.
(4) The fistulous tract is mobilized. The bladder site of the fistula is inverted
into the interior of the bladder with two rows of inverting sutures of chromic gut
number4-0. The muscularis and mucosa layers of the vagina are inverted into the
vaginal vault by means of two rows of sutures.
(5) The flaps of peritoneum are mobilized both from the bladder and from
the adjacent vaginal vault, and are closed to form a new vesicovaginal reflection of
peritoneum below the site of the old fistulous tract.
(6) The wound is closed in layers, as for laparotomy. Dressings are applied
and held in place with adhesive or plastic tape, and an indwelling catheter is left in the
2-17. RECTOVAGINAL FISTULA REPAIR--VAGINAL APPROACH
(1) This procedure involves vaginal repair of the perineum, fascia, and
muscle-supporting structures between the rectum and vagina, thereby closing the fistula
formed between the rectum and the vagina.
(2) A rectovaginal fistula occurs between the rectum and the vagina. In the
presence of a large rectovaginal fistula, a colostomy may be done.
b. Operative Procedure.
(1) The scar tissue and tract between the rectum and vagina are excised;
edges of fresh tissue are approximated with sutures of chromic gut number4-0.
(2) The rectum and vaginal walls are mobilized; the rectum is closed in
layers with inversion of the mucosa into the rectal canal.