New Surgical Technique: Meknes flap as an Interposition Tissue for Vesicovaginal Fistula Repair

Abstract

Objective:

Vesicovaginal fistula (VVF) is a stressful condition that affects the quality of life of patients. Many techniques were described to treat VVF with or without interposition tissue. ^1,2 The usual tissues of interposition may demand some expertise in harvesting or have scarce availability. ³ Accordingly, we set out to describe and demonstrate our new technique using an abundant and easy-to-harvest material. We use a vaginal flap (Meknes flap) as interposition tissue by vaginal approach in treating both primary and recurrent VVF.

Materials and Methods:

Seven patients were operated on. The mean age is 48 years old. Five patients presented post hysterectomy vesicovaginal fistula while two patients presented obstetrical fistula. Three patients were already operated on and presented a recurrent fistula. The mean time between the appearance of the fistula and the final treatment was 28 months. The mean size is 1.6 cm. All the fistulas were retrotrigonal.

Results:

In all cases, the vaginal flap was a feasible and efficient technique.

Conclusion:

This video provides a step-by-step description of performing a vaginal flap (Meknes flap) for treating VVF. This technique is easy, fast, and safe. It gives a supplementary layer in a multilayer approach. Its simplicity makes it possible to be practiced systematically in case of vesicovaginal fistula, improving the watertightness of the tissues.

The authors would like to thank Mrs. Fiqhi Zahra and Mr. Adil Doukkali for their technical support.

Patient consent statement: Written, informed consent for publication of their case was obtained from the patient prior to the procedure with an understanding that the video material would be utilized in an unidentified manner for publications in clinical journals.

Declaration of competing interest: The authors declare that they have no known competing financial interests that could have appeared to influence the work reported in this article. The authors declare that they do not have any commercial associations during the last 2 years that might create a conflict of interest in connection with the video.

Runtime of video: 7 mins 36 secs.