29: Laparoscopic Repair of Vesicovaginal Fistulae

Abstract

To report three cases of laparoscopic repair of vesicovaginal fistula following laparotomic hysterectomy. Three case reports. Obstetric and Gynecology Department of the University Hospital of Verona. Three patients, age 44, 45, 50 who complained about urinary incontinence because of vesicovaginal fistulae following laparotomic hysterectomy. The diagnosis was made by cystoscopy. The first case was a supratrigonal vesico-vaginal fistula of 2-3 mm; the second case a posterior-superior 5 mm fistula located to the trigone and the last case a supratrigonal fistula of 3 mm. Initially they had cystoscopy. A n° 8 pediatric Foley catheter was used to cannulate the fistula from the vagina into the bladder to help its identification and excision. A laparoscopic procedure was conducted. A vaginal probe was used for manipulating the vaginal vault. The peritoneum covered the vaginal cuff was dissected. The vesicovaginal space was developed laparoscopically and the bladder base was freed from the vaginal wall. The fistula was identified and excised. Extramucosal interrupted sutures 1-0 Vicryl were placed both in the bladder and into the anterior vaginal wall using extracorporeal knotting. Bladder integrity with contrast was done, an intraperitoneal drain was inserted and a Foley catheter was left in place in the bladder for 7 days. No complications were recorded. All the patients were discharged 3 days after surgery and at 4 weeks follow-up they did not complain about leakage. Vaginal examination confirmed complete repair. The minimally invasive approach of laparoscopy can represent an attractive option for patients with vesicovaginal fistula following surgery with advantages such as magnification during the procedure, shorter hospital stay and quicker recovery.