V2-13: Laparoscopic extravesical repair of vesicovaginal fistula
VideoIntroductions and Objectives
Vesicovaginal fistulas (VVF) are a well-documented complication of gynecologic surgery, with abdominal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. The trans-abdominal approach give good results even for difficult posteriorly located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair to minimize the surgical morbidity of the trans-abdominal approach.
A 44-year-old female presented with vesicovaginal fistula after total laparoscopic hysterectomy with right salphingo-oopherectomy and left salphingectomy. After a failed trial of conservative treatment with catheter drainage, a trans-peritoneal laparoscopic extravesical repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilateral ureteric catheterization._x000D_ A 4-port technique was performed with the patient in the Trendelenburg position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing with an interpositional omentum.
The operation was uncomplicated. Total operative time was 251 minutes. Normal diet was resumed on day 1 and patient was discharged on the same day with an indwelling catheter. A cystogram performed 3 weeks post surgery showed resolution of the fistula. Follow-up with the patient after 6 months showed complete continence and no recurrence of the VVF.
Laparoscopic extravesical repair of vesicovaginal fistula is a technically feasible and effective procedure that adheres to the principles of trans-abdominal open surgical repair and allows for bladder preservation in selected patients.