A vesico-vaginal fistula is diagnosed 10 days after an uncomplicated abdominal hysterectomy. There are no signs of sepsis and the margins are healthy but oedematous. What is the appropriate plan for definitive surgical repair?
- A Wait approximately 3 months before repair ✓
- B Immediate repair on the same admission
- C Permanent suprapubic catheter drainage
- D Urinary diversion with ileal conduit
Correct answer: A. Wait approximately 3 months before repair
Explanation
When a post-hysterectomy fistula is discovered after the first day or two, standard teaching is to allow inflammation and oedema to settle with free catheter drainage and repair at about three months, when tissues are vascular and suture holding is good. Immediate repair gives a higher failure rate. Diversion is reserved for fistulas unsuitable for reconstruction after repeated failed repairs.
Reference: DC Dutta's Textbook of Gynecology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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