The use of a rotational bladder flap for the repair of recurrent mixed trigonal-supratrigonal vesicovaginal fistulas

Objective To describe an approach for managing 10 patients with complex, mixed trigonal-supratrigonal vesi-ocovaginal fistulas (VVFs) using the rotational bladder flap technique. Methods: The 10 patients were undergoing their second to fourth repair of a mixed trigonal-supratrigonal VVF. The fistula was approached transabdominally, the bladder was opened along the sagittal plane and a bladder flap was rotated downward and medially to fill the fistula defect. First, the vaginal defect was repaired as usual: then, an omental flap was interposed and fixed between the vagina and bladder; finally, the fistula and posterior wall of the bladder were meticulously sutured in 1 layer. Results: Fistula closure was unsuccessful in 1 patient, in whom the corrugated drain had entered the bladder via the suture line. The fistulas were repaired successfully in the 9 remaining patients, with no recurrence or surgical reintervention for any reason for the follow-up duration. Conclusion: The rotational bladder flap technique is safe and effective for the repair of complex, mixed trigonal-supratrigonal VVFs which always require tension-free approximation. (c) 2012 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.