Vaginal and Laparoscopic Repair of Vesico-Vaginal Fistulae: A Comparison of Techniques

Abstract

<h3>Study Objective</h3> To compare vaginal and laparoscopic techniques for vesico-vaginal fistula (VVF) repair and suggest which situations may be appropriate for each technique. <h3>Design</h3> Video is used from two operations: a vaginal fistula repair using the Latzko technique and a laparoscopic repair using the O'Conor technique. <h3>Setting</h3> Both operations were performed in a standard gynecologic operating room with the patient in lithotomy position. For the laparoscopic repair, one 5mm umbilical port was used for the laparoscope, and two 5mm lateral ports were placed on each side to allow suturing by both surgeons. <h3>Patients or Participants</h3> One patient with a VVF resulting from a hysterectomy, and one patient with a VVF resulting from a cystotomy during an emergent cesarian delivery. <h3>Interventions</h3> The first patient, who had sufficient descent of the vaginal apex, underwent a Latzko-style vaginal repair. The vaginal epithelium was dissected away from the fistula opening, and the fistula tract was closed with a purse string suture and inverted with an additional suture. The vaginal epithelium was then closed interrupted sutures. The second patient, in whom the fistula was located in an inaccessible location high in the vagina, underwent a laparoscopic repair based on the O'Conor technique. The bladder was dissected away from the upper vagina. The bladder was entered near the site of the fistula and the fistula tract was excised. The bladder was closed in two layers, and the vagina was repaired in a single layer. <h3>Measurements and Main Results</h3> Both patients had resolution of urinary leakage and neither fistula recurred. <h3>Conclusion</h3> Vaginal VVF repairs are appropriate when VVF are accessible through the vagina, and a laparoscopic technique is appropriate for inaccessible VVF.