Surgical Repair of Vesicovaginal Fistula: A Variation of the Flap-Splitting Technique

Abstract

Video Objective To describe and demonstrate a variation of the flap-splitting technique for surgical correction of both small and medium sized vesicovaginal fistulas (VVF). Setting Patient A is a 51 year old woman who had undergone abdominal hysterectomy 10 years prior, and developed 2.5mm VVF, from which she experienced symptomatic leakage for many years. Patient B is a 53 year old woman who had undergone abdominal hysterectomy for cervical dysplasia and developed a 1cm VVF 2 months later. Both underwent successful surgical vaginal fistula repair. Interventions Surgical correction of vesicovaginal fistula via an alternative approach to the traditional flap-splitting technique. The 4 key steps consistent of exposure, lateral incision, mobilization of defect with multiple layer repair, and confirmation of adequate watertight seal. Conclusion Vaginal approach to repair should be considered whenever feasible. This variation to the flap splitting technique allows for adequate tissue mobilization without extension of defect.