V01-01 ROBOTIC-ASSISTED COMPLEX VESICOVAGINAL FISTULA MANAGEMENT WITH A VAGINAL FLAP

Abstract

You have accessJournal of UrologyIncontinence & Female Pelvic Medicine/Reconstructive Surgery (V01)1 Sep 2021V01-01 ROBOTIC-ASSISTED COMPLEX VESICOVAGINAL FISTULA MANAGEMENT WITH A VAGINAL FLAP Enanyeli Rangel, Laura C. Perez, Anibal La Riva, Aref S. Sayegh, Luis G. Medina, and Rene Sotelo Enanyeli RangelEnanyeli Rangel More articles by this author , Laura C. PerezLaura C. Perez More articles by this author , Anibal La RivaAnibal La Riva More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001970.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex fistulae represent a therapeutic challenge due to their increased recurrence rates. The lack of omentum and history of radiotherapy significantly impacts fistulae management. The aim of this video is to present the robotic management of a complex vesicovaginal fistula (VVF) using a vaginal flap in the case of omentum unavailability. METHODS: A 56-year-old female with previously diagnosed VVF, and rectovaginal fistula presented with persistent urine leakage per vagina despite conservative management with urinary and fecal diversion. Past medical history is positive for metastatic ovarian cancer managed with multiple surgeries and adjuvant chemoradiotherapy. Preoperative cystoscopy demonstrated VVF at the bladder trigone, and vaginoscopy showed a concomitant rectovaginal fistula. Under general endotracheal anesthesia, the patient was positioned in a dorsal lithotomy position. We proceed to identify and cannulate the fistulous tracts and ureters. A 12mm AirSeal® port was inserted in the right upper quadrant under direct vision. Once pneumoperitoneum was established, the rest of the robotic trocars were placed. Initially, extensive adhesiolysis was performed. Once the pelvis was free of adhesions, the vaginal apex was identified and then incised with cautery. We proceed to excise the VVF, and the bladder was closed with 2-0 V-Loc suture. The rectovaginal fistula was identified and excised. The rectum was separated from the vaginal wall. The excess of vaginal tissue was cut, and the vagina was shortened in order not to have overlapping suture lines. The vagina was closed with 2-0 V-Loc suture. Finally, fatty tissue and vaginal flap were mobilized to act as interposition tissues. A Blake drain was left in place. The robot was undocked, and the ports were closed in a standard fashion. RESULTS: Operative time was 11 hours, estimated blood loss was 300mL, and no intraoperative complications occurred. The patient was discharged on postoperative day 8. Posterior management included 37 sessions of hyperbaric oxygen therapy, and a reintervention 1-year after the surgery with a transvesical endoluminal bladder closure for a less than 1mm posterior fistula. Follow-up at 23-month after surgery shows an asymptomatic patient with no leakage. CONCLUSIONS: Vaginal flaps are feasible for managing complex vesicovaginal fistulae in case of omentum unavailability. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e62-e62 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enanyeli Rangel More articles by this author Laura C. Perez More articles by this author Anibal La Riva More articles by this author Aref S. Sayegh More articles by this author Luis G. Medina More articles by this author Rene Sotelo More articles by this author Expand All Advertisement Loading ...