Transvaginal Repair of Apical Vesicovaginal Fistula: A Modified Latzko Technique—Outcomes at a High-volume Referral Center

Abstract

BackgroundVesicovaginal fistula (VVF) is a distressing disorder in women. The transvaginal method of VVF repair is generally preferred, as its minimally invasive nature appears to offer several advantages compared with the abdominal approach, including decreased pain and blood loss and reduced hospital stay. A common technique used in VVF repair surgery is the Latzko technique, which may be difficult for the fistula located at the vaginal apex, due to the firm transverse scar left after the inciting gynecological surgery. ObjectiveTo show the efficacy and safety of an alternative modified transvaginal repair technique for apical vesciovaginal fistula. Design, setting, and participantsA retrospective cohort study was conducted at a high-volume hospital. A total of 108 female patients, previously diagnosed with apical VVF, underwent fistula repair between 2009 and 2016. Those patients were contacted, and they underwent a follow-up examination. Surgical procedureThe modified Latzko technique for apical VVF repair was performed. MeasurementsA chart review was performed. Results and limitationsThe mean age of the patients was 47 (22–77)yr. The average follow-up time was 40.7 (12–84)mo. The VVF was closed in all procedures. There was no immediate or delayed complication. All patients scored higher in the Patient Global Impression of Improvement questionnaire after the surgery. ConclusionsOur study indicates that the transvaginal repair of apical VVF with a modified Latzko technique is feasible and effective, and offers durable results without apparent complications. Patient summaryWe studied an alternative surgical technique for the treatment of apical vesicovaginal fistula. We conclude that this technique is simple, safe, and effective, with no apparent complications.