Repair of a vesico-vaginal fistula with amniotic membrane - Step 1 of the IDEAL recommendations of surgical innovation

Dimitri Barski, Holger Gerullis, Thorsten Ecke, Gabriella Varga, Mihaly Boros, Isabel Pintelon, Jean-Pierre Timmermans, Alexander Winter, Jens-Willem Bagner, Thomas Otto, Dimitri Barski, Holger Gerullis, Thorsten Ecke, Gabriella Varga, Mihaly Boros, Isabel Pintelon, Jean-Pierre Timmermans, Alexander Winter, Jens-Willem Bagner, Thomas Otto

Abstract

Introduction: Complex vesico-vaginal fistula (VVF) has a high recurrence rate and so the repair with graft tissues seems to be favorable. Amniotic membrane (AM) plays an increasing role as a scaffold for the repair of defect tissue due to its unique biological properties with regard to promoting wound healing.

Material and methods: An innovative surgical procedure for AM-assisted repair of a complex vesico-vaginal fistula as the Idea Stage following the IDEAL recommendations is presented. The development of amnion preparation and the involved surgical steps are described.

Results: We are able to report a successful repair of VVF by abdominal approach with an amniotic membrane graft. Good functional results, no adverse events and no graft rejection have been detected.

Conclusions: Favorable results confirm the technical simplicity, safety and efficacy of this procedure. Following the IDEAL recommendations, consecutive animal experiments and a cohort study are in progress.

Keywords: IDEAL recommendations; amniotic membrane; vesico-vaginal fistula.

Figures

Figure 1
Figure 1
Preoperative examination. A. Cystography showing the vaginal contrast leakage, indwelling ureteral stents. B. Cystoscopy showing the fistula canal at the bottom of the bladder.
Figure 2
Figure 2
Postoperative examination 3 months after the surgery. A. Cystography showing no contrast leakage, indwelling ureteral stents and catheter. B. Cystoscopy showing the amnion graft. AM merged with the surrounding bladder tissue at the margins but was still clearly demarcated with no signs of overgrowing urothelium or stroma. *, fixation points with suture.

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Source: PubMed

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