Laparoscopic Vesicovaginal Fistula Repair: A Novel Approach
Wichien Sirithanaphol MD*, Nipath Nethuwakul MD*, Ekkarin Chotikawanich MD*
Affiliation : * Department of Surgery, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Vesicovaginal fistula (VVF) is a common consequence of gynecologic procedures. Treatments include
transabdominal, transvaginal and laparoscopic surgery. New methods for laparoscopic VVF repair aim to improve treatment
outcomes and reduce post-operative complications.
Objective : To report a novel approach for laparoscopic VVF repair.
Material and Method: Medical records were reviewed of 5 patients who underwent a novel approach for laparoscopic VVF
repair for benign fistula between October 2008 and December 2010. None had previously undergone operative repair.
Preoperative cystoscopy revealed supratrigonal VVFs in all patients. Each patient was placed in the lithotomy position and
four or five trocars used. Cystoscopy combined with laparoscopy was performed to identify the site of the fistula. Limited
cystotomy was done and the fistula tract excised. The bladder and vagina were closed independently and the omentum
interposed between them.
Results : All cases were successfully managed using the laparoscopic technique. The respective mean operative time and
length of hospital stay was 229 min (range, 150-300) and mean 4.4 days (range, 4-6). All patients were able to take food and
drink within a day of surgery. The post-procedural cystogram showed no leakage. The urethral catheter was removed after
24.4 days (range, 18-34 days).
Conclusion : Laparoscopic transperitoneal repair of VVF is a feasible and safe technique, Cystoscopy combined with
laparoscopy simplifies limited cystotomy.
Keywords : Limited cystotomy, Surgical technique, VVF repair
