The Use of Small Intestinal Submucosa versus Standard Martius Flap for Trans-Vaginal Repair of Complicated Vesicovaginal Fistula

Abstract

SUMMARY AND CONCLUSION T his study proves that SIS interposition is safe, feasible and effective for repair of recurrent or large VVFs. The use of SIS as an inter-positioning layer is an efficient substitute for the use of Martius flap as an inter-positioning layer during vaginal repair of complex VVFs. In addition, the use of SIS decreases the operative time and make it simpler than the use of Martius flap in already complicated procedure. However, the potential benefits of this technique should be considered against the extra cost per patient. Small intestinal submucosa has several other advantages over Martius flaps in complicated cases. SIS was easy in application in addition to being safe (naturally derived biomaterial). Furthermore, it was also not time consuming and no extra incisions were needed that may cause disfigurement of external genitalia. Additionally, the use of SIS does not negate the use of Matius flaps simultaneously in exceedingly complicated cases. Whether this would create an additional benefit, was not studied in this work and may form the basis for a future study.

In conclusion, SIS is a valuable tool that can improve the outcome of the repair of VVFs and decreases the time and complexity of the procedure. To our knowledge, this is one of the first studies to report such advantage in such indication. The success of this material may encourage us and others in the future to use it in conjunction with Martius flab in very complicated fistula. It may also serve the base to use it in procedures of restoring continuity of the urinary tract