Abstract
Introduction and hypothesisTwo types of laparoscopic vesicovaginal fistula (VVF) repairs, the traditional transvesical (O’Conor) and extravesical techniques, dominate the literature. We present our 15-year experience of primary and recurrent cases of VVF utilizing an extravesical technique, which we first described in 1999.MethodsAn IRB approved retrospective study revealed 44 female patients with either primary or recurrent VVF. Laparoscopic extravesical repair was performed without an omental flap in the majority of cases. A three-layer closure technique was performed utilizing a double-layer bladder closure and a single-layer vaginal closure followed by bladder testing. A suprapubic catheter was utilized for 2–3 weeks postoperatively for bladder decompression.ResultsA review of our experience reveals a 97 % (32 out of 33) cure for primary VVF and 100 % (11 out of 11) rate for recurrent fistulas, with an overall cure rate of 98 % (43 out of 44) at a mean follow-up of 17.3 months (range 3–64). An omental flap was not utilized in 98 % of patients (43 out of 44), with a success rate of 98 % (42 out of 43). The mean estimated blood loss was 39 mL (range 0–450), mean hospital stay was 1.1 days (range 1–3), and none of the patients suffered any major intra- or postoperative complications. None of the patients required a conversion to open laparotomy.ConclusionsBased upon our experience we believe that performing laparoscopic extravesical VVF repair using a three-layer closure technique without an interposition omentum is a safe, effective, minimally invasive technique with excellent cure rates in an experienced surgeon’s hands.
Highlights
Introduction and hypothesisTwo types of laparoscopic vesicovaginal fistula (VVF) repairs, the traditional transvesical (O’Conor) and extravesical techniques, dominate the literature
Based upon our experience we believe that performing laparoscopic extravesical VVF repair using a three-layer closure technique without an interposition omentum is a safe, effective, minimally invasive technique with excellent cure rates in an experienced surgeon’s hands
We identified 48 patients with bladder fistulas, all of whom underwent either a laparoscopic VVF or vesicouterine fistulas (VUF) repair
Summary
Introduction and hypothesisTwo types of laparoscopic vesicovaginal fistula (VVF) repairs, the traditional transvesical (O’Conor) and extravesical techniques, dominate the literature. We present our 15-year experience of primary and recurrent cases of VVF utilizing an extravesical technique, which we first described in 1999. Laparoscopic extravesical repair was performed without an omental flap in the majority of cases. Our review of laparoscopic/robotic VVF approaches reveals that the most commonly performed approaches are the traditional O’Conor technique and the more recent, less well-known extravesical technique. The O’Conor technique [1] was first described in the 1970s and requires a bladder bivalving technique or cystotomy to identify and repair the VVF. The extravesical technique was first described in the late 1990s [2, 3] and is performed by focusing on a site-specific dissection and repair technique without cystotomy or bivalving of the bladder
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