Laparoscopic Vesicovaginal Fistula Repair with Limited Cystotomy: A Rewarding Treatment Option.

Journal of obstetrics and gynaecology of India

PubMedID: 27651632

Ghosh B, Biswal DK, Bera MK, Pal DK. Laparoscopic Vesicovaginal Fistula Repair with Limited Cystotomy: A Rewarding Treatment Option. J Obstet Gynaecol India. 2016;66(Suppl 1):370-6.
INTRODUCTION
Vesicovaginal fistula (VVF) is the most common type of urogenital fistula. Gynecologic surgery is the most common cause associated with it. Laparoscopic approach for VVF repair gives the benefit of minimally invasive surgery with principles similar to open transabdominal approach.

MATERIALS AND METHODS
We retrospectively reviewed data of 13 patients who underwent laparoscopic vesicovaginal repair at our department from December 2012 to December 2014. Transperitoneal transvesical laparoscopic vesicovaginal repair using 4 ports was performed in all cases. Small cystotomy was performed instead of classical bivalving of the bladder. In most of the cases, the sigmoid epiploic appendix was used for augmentation. Per urethral catheter was kept for 10 days.

RESULTS
In all patients, the procedure was successfully completed. Repairs were performed between 8 and 28 weeks (mean 15.8 ± 5.7) following the injury. All fistulas were at supratrigonal region. Fistula size ranged from 1 to 3.5 cm (mean 2.2 ± 0.9). Mean operative time was 157 ± 29.8 min (range 110-210), and estimated blood loss was 73.8 ± 18.2 ml (range 45-110). Average hospital stay was 4.6 days. In the postoperative period, three patients had urinary tract infection, which was treated with oral antibiotics. Apart from these, no major complications were seen. Follow-up time ranged from 4 to 27 months (mean 15.7). During the follow-up, no patient had recurrence or voiding symptoms.

CONCLUSIONS
Laparoscopic transabdominal transvesical VVF repair with limited cystotomy and sigmoid epiploic appendix flap coverage can be performed safely with short operative time, good success rate, less morbidity, and quick convalescence.