Immediate Laparoscopic Nontransvesical Repair without Omental Interposition for Vesicovaginal Fistula Developing after Total Abdominal Hysterectomy

Abstract

Immediate laparoscopic nontransvesical repair for vesicovaginal fistula may be an effective and feasible alternative to traditional repair in select patients.

Vesico vaginal fistula

“…Abdel Karim et al reported laparoscopic repair of VVF through transperitoneal extravesical route in 15 patients using omentum graft with 100% cure rates (26). Retrospective analysis of 5 patients who underwent immediate laparoscopic repair of VVF through extravesical technique without omental graft by Lee JH et al has shown promising results (27). Extravesical repair includes cystoscopy and ureteral catheterization and catheterization of the fistula, laparoscopic dissection of bladder from the vaginal wall and closure of bladder and vagina with an omentum interposition graft.…”

Transperitoneal Transvesical Laparoscopic Repair of Vesicovaginal Fistulae: Experience of a Tertiary Care Centre in Northern India

“…There are 2 basic principles of laparoscopic repair. These are transperitoneal nontransvesical approach [9,14,17,18] and transperitoneal transvesical approach respectively [10,11,12,15,16,17]. In present study, laparoscopic transvesical VVF repair was performed in all cases.…”

“…The abdominal approach is indicated selectively and these are the fistulae suitable for laparoscopic repair [10,11,12,13,14,15,16,17,18,19,20,21]. In present study our inclusion criteria were based primarily on supratrigonal or very high-up fistulas less than 2.5 cm with stenosed or incapacious vagina which makes them unsuitable for transvaginal repair.…”

“…The laparoscopic VVF repair has distinct technical advantages (table 3) reported in various studies [10,12,14,15,16]. There are many case reports and series on laparoscopic technique of VVF repair [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. These studies have variations in the basic techniques of approaching the fistula either by transvesical or extravesical routes, number of ports used, laparoconversions, differences in operative time, hospital stay, duration of catheterization, complications and overall success rate (table 4).…”

“…In present study, laparoscopic transvesical VVF repair was performed in all cases. In the technique of transperitoneal nontransvesical approach, Lee et al [14] described that posterior longitudinal cystotomy is not given rather they develop a plane between posterior bladder wall and anterior vaginal wall to reach the fistula. The vaginal and vesical fistulous openings are repaired separately without any interposition graft.…”