A 28-year-old woman sustained a large vesicovaginal fistula following obstructed labour. She presents 2 weeks postpartum. What is the correct timing for definitive surgical repair?
- A Immediate repair within 24 hours
- B Repair after 2 years
- C Repair after 12 weeks, once inflammation has settled ✓
- D Repair is contraindicated after obstetric fistula
Correct answer: C. Repair after 12 weeks, once inflammation has settled
Explanation
An obstetric fistula detected late is repaired after about 3 months (12 weeks), when sloughing is complete, oedema and inflammation have resolved, and tissues have regained a healthy blood supply, giving the highest success rate at the first attempt. Immediate repair is appropriate only when the injury is recognized intraoperatively or within the first 24 hours. Waiting years offers no advantage and prolongs suffering, and obstetric fistulas are among the most rewarding fistulas to repair surgically.
Reference: DC Dutta's Textbook of Gynecology, 7th ed.
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