FORMATION OF VESICOVAGINAL FISTULA - THE ROLE OF SUTURE PLACEMENT INTO THE BLADDER DURING CLOSURE OF THE VAGINAL CUFF AFTER TRANSABDOMINAL HYSTERECTOMY

OBJECTIVE: The objective of this study was to determine whether suture placement through the bladder during closure of the vaginal cuff at t he time of transabdominal hysterectomy is associated with formation of postoperative vesicovaginal fistula. STUDY DESIGN: Virgin female New Zealand White rabbits were used to perform this study. The study proto col was approved by the institutional Animal Use and Care Committee. A nimals were housed and maintained in the animal facilities al the Univ ersity of Mississippi Medical Center according to appropriate guidelin es. Thirty-two animals were randomized into two groups at a 2:1 ratio. All animals underwent transabdominal hysterectomy. Animals in group 1 (n = 21) had a figure-of-eight suture placed through the anterior vag inal cuff and intentionally into the bladder. Animals in group 2 (n = 11) were treated in an identical manner but care was taken to exclude the bladder when the suture was placed into the anterior vaginal cuff. Animals were put to death, and necropsy was performed 28 days after s urgery. The bladder and vagina of each animal were harvested en bloc. Evidence of a fistula between the bladder and vagina was then determin ed in three distinct ways. Infant formula was infused into the bladder through a urethral catheter, and the vagina was inspected for leakage . Saline solution tinted with methylene blue was used in the same mann er. Last, air was injected through the catheter into the bladder with the en bloc vagina and bladder preparation submerged in water. The vag ina was observed for air leakage manifest by bubble formation. RESULTS : The two groups were comparable in regard to weight gain, intraoperat ive complications, and postoperative complications. One animal in each group died. Neither had a surgical complication directly related to t he suture placement. During inspection of the vagina and bladder no an imal was noted to have a vesicovaginal fistula. CONCLUSIONS: A suture placed through the bladder during closure of the vaginal cuff after tr ansabdominal hysterectomy, as an isolated event, does not appear to be associated with formation of postoperative vesicovaginal fistula.