Laparoscopic vesicovaginal fistula repair: a novel approach.

BACKGROUND

Vesicovaginal fistula (VVF) is a common consequence of gynecologic procedures. Treatments include transabdominal, transvaginal and laparoscopic surgery. New methods for laparoscopic VVF repair aim to improve treatment outcomes and reduce post-operative complications.

OBJECTIVE

To report a novel approach for laparoscopic VVF repair.

MATERIAL AND METHOD: Medical records were reviewed of 5 patients who underwent a novel approach for laparoscopic VVF repair for benign fistula between October 2008 and December 2010. None had previously undergone operative repair Preoperative cystoscopy revealed supratrigonal VVFs in all patients. Each patient was placed in the lithotomy position and four or five trocars used. Cystoscopy combined with laparoscopy was performed to identify the site of the fistula. Limited cystotomy was done and the fistula tract excised. The bladder and vagina were closed independently and the omentum interposed between them.

RESULTS

All cases were successfully managed using the laparoscopic technique. The respective mean operative time and length of hospital stay was 229 min (range, 150-300) and mean 4.4 days (range, 4-6). All patients were able to take food and drink within a day of surgery. The post-procedural cystogram showed no leakage. The urethral catheter was removed after 24.4 days (range, 18-34 days).

CONCLUSION

Laparoscopic transperitoneal repair of VVF is a feasible and safe technique, Cystoscopy combined with laparoscopy simplifies limited cystotomy.