Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience

Abstract

Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital.
 Method: A 31-year-old female presented with vesicovaginal fistula
 after cesarean section. Patient complained of urinary incontinence
 since 5 years ago. After a failed trial of conservative treatment with
 catheter drainage, a transperitoneal laparoscopic repair was performed.
 Initially, cystoscopy was performed to confirm the fistula location
 and for bilateral ureteric catheterization. A 4-port technique
 was performed with the patient in lithotomy position and slightly
 Trendelenburg. Without opening the bladder, the fistula tract was
 excised and the bladder was separated from the anterior vaginal
 wall. Both the bladder and vaginal walls were then closed separately
 using intracorporeal suturing, interposed with the omentum.
 Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery,
 and the patient was discharged on the second day with an indwelling
 catheter. Surgical wound showed good cosmetic result and no
 leakage was identified from cystogram after 2 weeks. The catheter
 was removed after 2 weeks.
 Conclusion: Laparoscopic transperitoneal repair of vesicovaginal
 fistula with omentum inteposition is feasible in Dr. Hasan Sadikin
 Hospital with good outcome, short hospital stay, and good cosmetic
 result.
 [Indones J Obstet Gynecol 2014; 4: 223-225]
 Keywords: laparoscopy, vesicovaginal fistula