Repair of complex XXXX by combining a rotational bladder flap and full thick vascular peritoneal interposition.

@entity1 @entity789 @entity292 @entity3622
PURPOSE: To present the experience of repairing iatrogenic @entity789 ( @entity789 ) using a rotational bladder flap and peritoneal interposition technique. METHODS: Between January 2009 and June 2014, a total of 18 @entity1 (mean age, 44.0 years; age range, 29-51 years) with @entity789 were treated using a transperitoneal approach. All @entity789 were complications of gynecologic procedures. Twelve @entity1 experienced recurrent @entity789 and one @entity1 had a concomitant @entity3622 after radiotherapy. The @entity292 was approached transabdominally. The peritoneum covering the bladder was isolated to expose the bladder and prepare for the interposition. The bladder was opened along the sagittal plane to the @entity292 and a bladder flap was rotated downward to fill the @entity292 defect. The vaginal defect was closed, then a flap using the isolated peritoneum was interposed and fixed between the vagina and bladder. A ureteral re-implantation was performed in one @entity1 . All VVF procedures were performed by one urologist (SW). Repair of the @entity3622 was performed by a general surgeon at the same time. RESULTS: Seventeen @entity1 (success rate   =   94% [100% for primary cases and 92% for recurrent cases]) had no evidence of recurrent VVF at a mean follow-up of 20 months (range, 6-36 months). The only @entity1 who had previously undergone a repair procedure failed. CONCLUSIONS: A transperitoneal approach with the use of a rotational bladder flap and peritoneal interposition might be a feasible and reliable procedure for surgical management of iatrogenic @entity789 , especially in complicated cases. Neurourol. Urodynam.    2015 Wiley Periodicals, Inc.
