Vesicovaginal fistula repair: review of surgical technique in a unique case of recurrence

Abstract

Our video aims to provide an update in the background of vesicovaginal fistulas and demonstrate the Latzko procedure and its application in a case of recurrent vesicovaginal fistula. Vesicovaginal fistula (VVF) is a rare complication of gynecologic surgery, complicating an estimated 0.12% of simple hysterectomies and 1.14% of radical hysterectomies. The Latzko technique is a first line repair approach that involves transvaginal repair and can be highly effective in even complex fistulae. One of the most common complications of fistula repair is recurrence, which often requires a more complex repeat repair using tissue grafts and/or abdominal approach. In our video, we demonstrate the Latzko procedure and its application in a unique case of recurrent VVF. We begin our case by performing a cystoscopy and identifying the fistulous tract in relation to the ureteral ostia, cannulate to aid in dissection, and then proceed with our dissection. We utilize local anesthesia for hydro dissection and stay sutures to aid in closure. Once excised, the fistulous tract is then closed in a tension-free manner with multiple layers and non-overlapping suture lines. A cystoscopy is then performed to confirm a watertight closure and patency of the ureteral ostia bilaterally. Lastly, the vaginal epithelium is closed transversely. In summary, our video provides an update in the background information of vesicovaginal fistula, presentation of a unique case of recurrence, and demonstration of utilizing the Latzko technique for an effective closure of recurrent fistula. We thank you very much for your time and hope that this video aids in your surgical education.