The AINU Technique for Laparoscopic Vesico-Vaginal Fistula Repair: A Preliminary Report

Abstract

Introduction: With safe obstetric practices now globally available, most vesico-vaginal fistulas (VVF) presenting in recent times are secondary to various gynecologic surgeries. Most of them are supra-trigonal in location. Laparoscopic repair of VVF is gaining ground as an alternative to open repair of VVF. In this study, we describe our initial experience with a novel technique of laparoscopic VVF repair involving a limited transverse cystotomy for access and a single-layered barbed suture closure of bladder. Materials and Methods: Twenty cases of supra-trigonal VVFs following gynecologic surgeries were taken up for repair by our novel technique. The mean age of the patients was 32 years and the mean VVF size was 1.5 cm. Results: The mean operative time was 54 min. Estimated mean blood loss was 30 ml and the mean postoperative stay was 2.5 days. None of the patients had any recurrence with a mean follow-up of 14 months. Conclusion: The limited transverse cystotomy approach has advantages in decreasing the operative time, improving ease of laparoscopic suturing, allowing an automatic separation of suture lines and allowing for an easier anterior dissection of the bladder to reduce tension on the suture line if necessary. Further this approach provides excellent results in select patients of supra-trigonal VVF in terms of continence and postoperative bladder overactivity.

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

“…Additionally, with the development of the minimally invasive technique, laparoscopic repair became a good choice to treat VVF [24] . We compared the fistula and patient characteristics in 2 populations undergoing surgical repair via different surgical approaches.…”

Diagnostik und Therapie vesikovaginaler und ureterovaginaler Fisteln

“…Im Kontrast hierzu steht in den Industrienationen die seltene Geburtsfistel im Verhältnis von mindestens 1:9 einer steigenden Anzahl an iatrogenen, postoperativen Fisteln gegenüber [8]. Dabei birgt die abdominelle Hysterektomie, bei der es unweigerlich zu Devaskularisierung der unteren Uretersegmente kommt, das größte Risiko für die Ausbildung einer Fistel [9,10]. So beschrieben Härkki-Siren et al [11] für die Hysterektomien in Finnland, eine methodenübergreifende Fistelrate von 1:1250, wobei sich für die laparoskopischen Hysterektomien eine Fistelrate von 1:455 identifizieren ließ, für abdominale von 1:1000 und für die vaginale Hysterektomie von 1:5000.…”

“…In der Beurteilung der VVF und UVF geht es jedoch nicht nur um die Bestätigung einer tatsächlichen Fistelanlage, sondern auch um die Einschätzung von Größe, Anzahl und exakter Lokalisation der Fistel oder Fisteln, wobei die meisten VVF supratrigonal gelegen sind [10]. Dieses Vorgehen erlaubt eine genaue Therapieplanung und verbessert so das Outcome der Patientin.…”

Vesicovaginal fistula: Review and recent trends

“…[44] This classical approach has been questioned by newer and recent techniques that report similar outcomes. These include limited vertical cystotomy,[45] horizontal cystotomy,[46] and intravesical repair[47] of VVF. These approaches have been proposed to: (1) decrease the operating time (2) improve the ease of laparoscopic suturing leading to better luminal delineation, (3) decrease the incidence of overactive bladder, and (4) help in early anterior dissection which reduces the tension on the suture line.…”

“…These approaches have been proposed to: (1) decrease the operating time (2) improve the ease of laparoscopic suturing leading to better luminal delineation, (3) decrease the incidence of overactive bladder, and (4) help in early anterior dissection which reduces the tension on the suture line. [46] Limiting the dissection while following the principles of VVF repair is claimed to provide better post operative recovery, however, long-term results of these techniques need evaluation.…”