V2-13 LAPAROSCOPIC EXTRAVESICAL REPAIR OF VESICOVAGINAL FISTULA

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-13 LAPAROSCOPIC EXTRAVESICAL REPAIR OF VESICOVAGINAL FISTULA Xiao Han, Ho Yee Tiong, and David Consigliere Xiao HanXiao Han More articles by this author , Ho Yee TiongHo Yee Tiong More articles by this author , and David ConsigliereDavid Consigliere More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.338AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicovaginal fistulas (VVF) are a well-documented complication of gynecologic surgery, with abdominal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. The trans-abdominal approach give good results even for difficult posteriorly located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair to minimize the surgical morbidity of the trans-abdominal approach. METHODS A 44-year-old female presented with vesicovaginal fistula after total laparoscopic hysterectomy with right salphingo-oopherectomy and left salphingectomy. After a failed trial of conservative treatment with catheter drainage, a trans-peritoneal laparoscopic extravesical repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the Trendelenburg position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing with an interpositional omentum. RESULTS The operation was uncomplicated. Total operative time was 251 minutes. Normal diet was resumed on day 1 and patient was discharged on the same day with an indwelling catheter. A cystogram performed 3 weeks post surgery showed resolution of the fistula. Follow-up with the patient after 6 months showed complete continence and no recurrence of the VVF. CONCLUSIONS Laparoscopic extravesical repair of vesicovaginal fistula is a technically feasible and effective procedure that adheres to the principles of trans-abdominal open surgical repair and allows for bladder preservation in selected patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e101 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xiao Han More articles by this author Ho Yee Tiong More articles by this author David Consigliere More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...