摘要
Objective It has been a general rule t o wait with the repairof an obstetric fistula for a minimum period of 3months allowing the patient to become an out cast.In a prospective way an immediate management was studied and antibiotics were not used,all according to basic surgical principles.Methods A total of 1716patients with a fistula duration of 3to 75days after delivery were treate d immediately on pre-sentation by catheter and /or early c losure.Instead of an-tibiotics,a high oral fluid regimen was instituted.The fistulas were classified according to anatomic and physio-logic location in types I,IIAa,IIAb,IIBa,and IIBb,and according to size in small,medium,l arge,and extensive.The operation became progressively more complicated from type I through type IIBb and from small through extensive.Results At first attempt 1633fistul as(95.2%)were closed and another 57could be closed at further attempt (s),ac-counting for a final closure in 1690p atients(98.5%);264patients(15.4%)were healed by catheter only.Of these 1690patients with a closed fis tula,1575(93.2%)were continent and 115(6.8%)were incontinent.The results as to closure and to continen ce became progressively worse from type I through type IIBb an d from small through extensive.Postoperative wound inf ection was not noted;postoperative mortality was encountered in 6patients(0.4%).Conclusion This immediate managem ent proves highly effective in terms of closure and continence and will prevent the patient from becoming an outcast with progres-sive downgrading medically,socially,and mentally.
Objective It has been a general rule t o wait with the repairof an obstetric fistula for a minimum period of 3months allowing the patient to become an out cast.In a prospective way an immediate management was studied and antibiotics were not used,all according to basic surgical principles.Methods A total of 1716patients with a fistula duration of 3to 75days after delivery were treate d immediately on pre-sentation by catheter and /or early c losure.Instead of an-tibiotics,a high oral fluid regimen was instituted.The fistulas were classified according to anatomic and physio-logic location in types I,IIAa,IIAb,IIBa,and IIBb,and according to size in small,medium,l arge,and extensive.The operation became progressively more complicated from type I through type IIBb and from small through extensive.Results At first attempt 1633fistul as(95.2%)were closed and another 57could be closed at further attempt (s),ac-counting for a final closure in 1690p atients(98.5%);264patients(15.4%)were healed by catheter only.Of these 1690patients with a closed fis tula,1575(93.2%)were continent and 115(6.8%)were incontinent.The results as to closure and to continen ce became progressively worse from type I through type IIBb an d from small through extensive.Postoperative wound inf ection was not noted;postoperative mortality was encountered in 6patients(0.4%).Conclusion This immediate managem ent proves highly effective in terms of closure and continence and will prevent the patient from becoming an outcast with progres-sive downgrading medically,socially,and mentally.
