Transvaginal Approach

The principals of TV repair are creation of anterior vaginal flap and a tension-free multilayered closure. The TV approach is the safest and less morbid for patients. It is ideal for fistulas located low in the vaginal wall, or in the bladder neck or proximal urethra. TV repairs do not require the excision of the fistulous tract, and therefore no need to perform ureteral reimplant. For simple, small, and mature fistulas, a transvaginal partial colpocleisis (Latzko procedure) is indicated.11 If the fistulous tract is large, it can be excised, and closure is performed in overlapping layers once tissue is widely mobilized. The bladder is closed continuously with 4-0 chromic sutures, and the pubocervical fascia is closed in two layers (Figure 13-1.1, Figure 13-1.2). More complicated fistulas may require a labial fat or peritoneal pad (Figure 13-1.3).

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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