Iliocostalis Muscle Rotational Flap: A Novel Flap for Esophagopleural Fistula Repair

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

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Effect of Paula exercise method on functional outcomes of women with post fistula repair incontinence: a protocol for randomized controlled trial

BMC Women s Health ◽

10.1186/s12905-021-01249-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saratu Umar Aliyu ◽

Shmaila M. Hanif ◽

Isa Usman Lawal

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Randomized Controlled Trial ◽

Pelvic Floor ◽

Controlled Trial ◽

Fistula Repair ◽

Randomized Controlled ◽

Urine Leakage ◽

Pelvic Floor Strength

Abstract Background Post-fistula-repair incontinence (PFRI) is a common complication of vesicovaginal fistula (VVF) surgeries. It entails continuous leakage of urine after successful VVF closure. Pelvic Floor Muscle Training (PFMT) plays a vital role in the management of PFRI, however, an evolving exercise approach is the Paula Exercise Method (PEM) which has shown a promising effect in stopping urinary incontinence, but there is no data on its effect on PFRI. This study therefore, proposes to primarily investigate the effect of PEM on urine leakage and secondarily, pelvic floor strength (PFS), quality of life (QoL), sexual function (SF), and mental health (MH) in women with PFRI. Methods This is a study protocol for a randomized controlled trial. A total of 182 participants are expected to participate in the study after satisfying the inclusion criteria. The participants will be randomized into either PEM or PFMT study groups. The demographic data of all the participants will be recorded. Each participant will be assessed for urine leakage, PFS, QoL, SF, and MH at baseline and subsequently, at four, eight and 12 weeks of intervention. Demographic parameters will be summarized using descriptive statistics. Continuous data will be computed for differences using inferential statistic of Analysis of variance, t-test and Man Whitney U as appropriate. All analyses will be performed using SPSS version 22.0 with probability set at 0.05 alpha level. Discussion It is hoped that the outcome of this study will determine the effect of the Paula exercise method on urine leakage, pelvic floor strength, quality of life, sexual function, and mental health among women with post-fistula-repair incontinence and also provide evidence for the use of the Paula method in urinary incontinence. Trial registration: Pan African Clinical Trials Registry (www.pactr.org), identifier PACTR201906515532827.

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Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

BMC Women s Health ◽

10.1186/s12905-021-01175-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christl Reisenauer ◽

Bastian Amend ◽

Claudius Falch ◽

Harald Abele ◽

Sara Yvonne Brucker ◽

...

Keyword(s):

Pelvic Floor ◽

Developed Countries ◽

Vaginal Wall ◽

Fistula Closure ◽

Fistula Repair ◽

Anterior Position ◽

Multiparous Women ◽

Uncommon Condition ◽

Rectovaginal Fistulas ◽

Vesicovaginal Fistulas

Abstract Background Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre. Methods Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively. Results Eleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9/11), and rectovaginal fistulas were more common in primiparous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure. Conclusions In developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon’s experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out. Trial registration Retrospectively registered, DRKS 00022543, 28.07.2020.

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Addition to the Toolbox of Surgical Techniques for Palatal Fistula Repair

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211003796 ◽

2021 ◽

pp. 105566562110037

Author(s):

Catherine de Blacam ◽

David Orr

Keyword(s):

Bone Graft ◽

Cancellous Bone ◽

Hard Palate ◽

Surgical Techniques ◽

Cancellous Bone Graft ◽

Fistula Repair ◽

Palatal Fistula

In response to the article by Rothermel and colleagues, the authors suggest the use of cancellous bone graft for repair of fistulae of the hard palate as an addition to the proposed toolbox.

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7 Perilymph Fistula Repair

Surgical Pediatric Otolaryngology ◽

10.1055/b-0036-132053 ◽

2016 ◽

Keyword(s):

Fistula Repair

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Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620959528 ◽

2021 ◽

Vol 58 (5) ◽

pp. 603-611

Author(s):

Giap H. Vu ◽

Christopher L. Kalmar ◽

Carrie E. Zimmerman ◽

Laura S. Humphries ◽

Jordan W. Swanson ◽

...

Keyword(s):

Cleft Palate ◽

Outcome Measure ◽

Charge Ratio ◽

Fistula Repair ◽

Case Volume ◽

Secondary Surgery ◽

Hospital Case ◽

Oronasal Fistula ◽

Cleft Palate Repair ◽

Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

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