V12-03: A new laparoscopic minimally invasive technique of transposing omentum to perineum for recto urethral fistula.
Rectourethral fistula is a morbid complication that can occur post trauma, radical prostatectomy, radiation, or after pelvic surgery. The management of these cases can be challenging and might require multiple procedures to achieve a cure. The use of omentum flap between the rectum and the urethra is recommended for its potential benefits in prevention of fistula recurrence. We aim to illustrate the feasibility and safety of a new laparoscopic surgical technique for interposition of omentum in patients with rectourethral fistula (RUF).
We performed a prospective case series of 3 patients who presented to our center with PFUI and RUF from September 2014 till October 2014. These patients underwent laparoscopic omentoplasty combined with progressive perineal approach for urethroplasty. The primary study outcome was the success rate of the surgical technique and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed or the recurrence of RUF.
Median age is 30 years old (28-33). All 3 patients had complex PFUI with RUF. They all had an attempt of perineal anastomotic urethroplasty with RUF repair that failed outside our center and were referred to us subsequently. All the patients had supra pubic catheters and 2 of the three patients were passing urine through the rectum and the urethral meatus. One of the patients had a loop colostomy that was closed during the first failed surgery. No intra-operative or postoperative complications occurred. Patients were discharged home on post-operative day 3. All 3 patients had the urethral catheter removed after 6 weeks. 3 months follow up shows no fistula recurrence with good urine flow.
Using our new technique of laparoscopic Omentoplasty, interposition of omentum in patients with RUF post PFUI is a viable and safe option. This allows us to perform a perineal surgery with the benefit of omental interposition using a minimally invasive technique. The complications of transpubic approach are avoided. This novel technique of Omentoplasty is beneficial for patients with recto urethral fistula due to pelvic fracture urethral injury, post radical prostatectomy fistula and post radiation fistula._x000D_ The indications would broaden in coming future._x000D_