Interposing layer of fibrin glue: A new horizon in vesico-vaginal fistula repair

Abstract

Aim: In this study our idea is to compare the effectiveness of using interposing layer of fibrin glue to omental flap in reducing the failure of laparoscopic vesicovaginal fistula repair. Methods: Forty patients with fairly large vesicovaginal fistula were enrolled and divided in two groups of 20 each. We have used fibrin glue in one group and omental flap in the other group. Result: Of 20 patients in fibrin glue group no failure was seen, while 5 patients out of 20 in omental flap group had failure. Conclusion: This result is statistically significant and hence use of fibrin glue to be considered during laparoscopic repair of vesicovaginal fistulas.

Repair of Vesicovaginal Fistulae

“…There was no difference in success rate for these vaginal vesicovaginal fistula repairs. Similar findings were noted in a prospective nonrandomized comparative study by Choudhury et al 21 assessing laparoscopic repair with fibrin glue compared with an omental flap (Appendix 11, available online at http://links.lww.com/AOG/ D510).…”

“…Three of the 11 RCTs were at low risk of bias 15,38,50 and the remainder were at high risk of bias because of study design and inconsistencies. 13,21,36,46,47,[53][54][55] All retrospective nonrandomized comparative studies (30 studies) and prospective nonrandomized comparative studies (5 studies) were considered high risk of bias because these studies evaluated interventions designated by surgeon preference, varied in their follow-up, provided limited information on evaluation of cure, and did not control for confounding factors. 14,[16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35]37,[39][40][41][42][43][44][45]48,49,51,52,[56][57][58] One comparative study, by Geisler et al, …”

“…The evaluated domains included route of repair and the use of flaps, trimming, layered closure, antibiotics, fascial sling, and fibrin glue (Table 1). 13,14,[16][17][18][20][21][22][23][24][27][28][29][30][31][33][34][35][36][37][40][41][42][44][45][46][48][49][50][51][52][53][56][57][58] Seventeen studies were identified (two prospective nonrandomized comparative studies, 15 retrospective nonrandomized comparative studies) that evaluated vaginal compared with abdominal (through laparotomy) routes of vesicovaginal fistula repair (N51,143). 14,16,18,20,24,29,30,33,35,37,40,41,…”

“…closure compared with repair with the use of suture and interpositional flap. 21,46 Surgeon preference and experience primarily influence surgical planning, including route of repair and techniques: for example, trimming, use of interpositional flaps, suture type, and layers of closure. Other factors that are likely influencing medical decision making include characteristics of urine leakage, fistula size, number of fistulae, location, and degree of fibrosis.…”

The Microcirculation of Vaginal Tissue in Women with Obstetric Vesicovaginal Fistula and Short-Term Effects of Surgical Repair on Microvascular Parameters

“…However, in light of the results of this study, i.e., relatively good vasculature, it is questionable whether angiogenic-inducing strategies will be beneficial to surgical outcomes. Other potential promising treatment options for VVF repair include tissue-engineered biomaterials (e.g., amnion) or tissue sealants (e.g., fibrin glue, cyanoacrylate, autologous cell injection, or other bioglues), although most of these innovations are still in a preclinical phase [25][26][27][28][29][30].…”