Laparoscopic Transabdominal Transvesical Vesicovaginal Fistula Repair

Abstract

Transabdominal transvesical repair has been the standard management for difficult vesicovaginal fistulae as a result of obstetric and gynecologic surgery. We describe a laparoscopic transvesical technique that minimizes operative morbidity. This retrospective study included 25 women who underwent laparoscopic surgery for vesicovaginal fistula from June 2003 to November 2008. All patients were underwent laparoscopic surgery by the transabdominal transvesical route. Patients were investigated by intravenous urography, micturating cystography, cystoscopy, and retrograde pyelography. Of the 25 patients who underwent laparoscopic surgery, 3 patients' operations had to be converted to open surgery because of dense adhesions. Of the 22 cases completed laparoscopically, leakage per vagina occurred in 3 patients. One patient underwent fulguration of residual fistula and was cured, one underwent vaginal repair, and other patient was lost to follow-up. Laparoscopic transvesical vesicovaginal fistula repair appears to be a safe and effective procedure that adheres to the principles of a transabdominal transvesical fistula repair while decreasing morbidity and improving cosmesis.