Laparoscopic Transvesical Vesicovaginal Fistula Repair

Abstract

Background and Purpose:

Transabdominal transvesical vesicovaginal fistula repair has become the standard treatment of difficult vesicovaginal fistulae. To decrease operative morbidity, transvaginal repairs were introduced, having success rates lower than that of open surgery. We describe a laparoscopic transvesical technique that duplicates the steps of the open operation while minimizing operative morbidity; this technique also minimizes operative morbidity while adhering to the principles of transabdominal repair as described by O'Conner.

Technique:

The patient is placed in the lithotomy position using Allen stirrups, and bilateral SF open-ended ureteral catheters are placed cystoscopically. Using four laparoscopic ports, the prevesical space is accessed. The bladder is bivalved down to the fistula, and stay sutures are placed at the bladder edges for exposure. The fistulous tract and adjacent fibrotic tissue are excised, and the bladder and vagina are closed separately with single layers of full-thickness interrupted 2-0 Vicryl sutures. An omental flap is interposed between suture lines in the bladder and vagina. The ureteral catheters are sequentially removed on the first and second postoperative days. A gravity cystogram is performed 3 weeks postoperatively; if it is normal, the urethral catheter is removed.

Results:

This procedure has been performed on two consecutive patients who had failed prior Latzko repairs. Both patients were discharged 2 days postoperatively without complications. At a follow-up of 41 months in the first patient and 39 months in the second, no fistula recurrence has been seen.

Conclusions:

Laparoscopic transvesical vesicovaginal fistula repair appears to be a safe and effective procedure that adheres to the principles of a transabdominal transvesical fistula repair while decreasing morbidity and improving cosmesis. Continued follow-up is required to determine its long-term efficacy compared with the accepted open transabdominal and transvaginal approaches.

No competing financial interests exist.

Runtime of video: 7 min 35 sec