[Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination]

Pneumovesical vesicovaginal fistula repair: Lessons learned from an initial series of 25 patients

OBJECTIVES

This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF).

MATERIALS AND METHODS

A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time.

RESULTS

Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern.

CONCLUSION

Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary.

Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

BACKGROUND

A vesicovaginal fistula is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition, the sequelae from these fistulae have a profound effect on the patients in view of their physical, psychological, and social dimensions. The treatment of vesicovaginal fistula is surgical in most cases and the choice of the repair technique is controversial. We evaluated the benefits of a laparoscopic approach in a patient with vesicovaginal fistulae. Here, we present our first experience using a simplified laparoscopic approach technique to repair vesicovaginal fistulae in our country.

CASE PRESENTATION

A 46-year-old Javanese woman presented with urinary incontinence following an abdominal hysterectomy 3 months earlier and received laparoscopic repair. A cystoscopy was performed to confirm the fistula orifice and a stent was inserted into the fistula tract from her bladder to her vagina. A tamponade was inserted into her vagina up to the vaginal apex, to be able to identify the vagina. She had adhesions; therefore, adhesiolysis was performed using a combination of sharp and blunt dissection to expose the vaginal stump and the superior aspect of her bladder. A simple cystotomy was performed and extended to include the fistulae site, and then the defect was repaired by using a running stitch. A second layer of closure was performed in an imbricating fashion with the same suture. The vagina defect was not closed separately but covered with an omental flap. This procedure takes approximately 2.5 hours; estimated blood loss was minimal and there were no intraoperative complications. She had no recurrent symptoms 6 months after surgery.

CONCLUSION

Our case report concludes that the simplified laparoscopic approach to vesicovaginal fistulae is a viable option for successful repair and that it reduces the size of bladder opening, causes minimal bleeding, and gives successful relief.

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

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.