Laparoscopic Repair of Recurrent Vesicovaginal Fistula Using Omental Flap

Abstract

In the United States, 80% of vesicovaginal fistulas are secondary to benign gynecologic surgery with a reported incidence of 1:1300 after hysterectomy. Recurrent fistulas can be difficult to manage. This video reviews the indications and basic principles of abdominal repair of vesicovaginal fistulas and demonstrates our successful laparoscopic repair technique on a 50 year-old female with a recurrent fistula at the vaginal apex after hysterectomy who had previously failed a vaginal repair. The fistula tract was excised and an omental flap was interposed between the bladder and vaginal incisions to provide vascular supply as well as to act as a physical barrier in an effort to prevent recurrence. The patient was discharged home the following day, and continuous bladder draining was maintained for two weeks at which time a voiding cystourethrogram showed an intact bladder. At two-month follow-up the patient was very satisfied and had no evidence of fistula recurrence.