Obstetric fistula (or vaginal fistula) is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina (see rectovaginal fistula) or between the bladder and vagina (see vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available.
History of the Procedure
The earliest evidence of a VVF was found in 1923, when Derry examined the mummified body of Henhenit, a lady in the court of Mentuhotep of the 11th dynasty who reigned around 2050 BC. These dissections revealed a large VVF in a markedly contracted pelvis. The Kahun papyrus and Ebers papyrus failed to mention VVF. However, not until 950 AD did Avicenna correlate the combination of pregnancy at a young age and difficult labor with the formation of a vesicovaginal communication. The term fistula (previously called ruptura) was not used until 1597, when Luiz de Mercado first coined the term.
The first basic surgical principles for the repair of VVFs were described in 1663 by Hedrik von Roonhuyse. He stressed the use of a speculum and the lithotomy position to gain adequate exposure and denudation of the margin of the bladder wall, with reapproximation of the edges using sharpened swan quills. Later, using Roonhuyse’s technique, Johann Fatio documented the first successful VVF repair in 1675. However, not until the 19th century did successful repair of VVFs become common. In 1834, Jobert de Lamballe published a report of his VVF repairs in which skin flaps were used in the vagina. Later, he advocated the use of tension-free closures using vaginal-releasing incisions.
