Our experience with laparoscopic repair of the vesicovaginal fistula

Abstract

Background: The incidence of vesicovaginal fistula ranges from 30,000 to 130,000 cases per year, and it is generally associated with abdominal hysterectomy, cancer, and pelvic radiation. Vaginoscopy, cystoscopy, and cystography are necessary for its diagnosis. The best opportunity for achieving favorable results is in the first surgical intervention.
 Objective: To report the results of laparoscopic vesicovaginal fistula repair at our hospital center.
 Materials and methods: A descriptive, ambispective study was conducted on patients with vesicovaginal fistula that underwent laparoscopic repair within the time frame of March 2016 to November 2019.
 Results: Fifteen patients that underwent laparoscopic vesicovaginal fistula repair were included. They had a mean age of 46.2 years and a mean BMI of 30.1 kg/m2. The most frequent comorbidity was high blood pressure, followed by endometrial cancer. All patients had a history of gynecologic surgery. One patient presented with recurrence and one patient had a Clavien-Dindo III complication (6.67%).
 Discussion: In our study, 93.33% of the cases were caused by hysterectomy. The patient that had vesicovaginal fistula recurrence presented with mild tissue fibrosis at the supratrigonal location, and a 3 mm fistula, contrary to that reported in the literature.
 Conclusion: Video-assisted laparoscopic repair at our hospital was shown to be a safe procedure, with a success rate of 93.3% (14 patients) in the first intervention. In addition to the presence of a moderate fibrotic process that could condition greater technical difficulty, intraoperative blood loss was >250 cc and hospital stay was >3 days.