Laparoscopic transvesical repair of recurrent vesicovaginal fistula using with fleece-bound sealing system.

BACKGROUND

Vesicovaginal fistula (VVF) is an epithelium-lined communication between the urinary bladder and vagina. Most of VVFs are repaired by conventional open surgery. Laparoscopic repair of VVFs is rare and so far no report is available about laparoscopic repair of persistent VVF using fleece-bound sealing system as a tissue barrier in the literature. Here we describe the operative technique and briefly review the literature.

CASE: We present the case of a 37-year-old woman with recurring VVF in two times after abdominal and transvaginal repairs caused by a massive bleeding during caesarian-section due to placenta previa and underwent hysterectomy. During the laparoscopic repair of the fistula and excision of the vaginal cuff, fleece-bound sealing system (TachoSil) was used as tissue barrier. Laparoscopic transperitoneal transvesical repair was successfully performed by suturing the defects and fixing two TachoSil between the bladder and vagina. The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found.

CONCLUSION

We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity. Whilst proper identification of tissue planes and good laparoscopic suturing technique are required, using fleece-bound sealing system might be convenient especially for persistent VVF.