Laparoscopic Vesicovaginal Fistula Repair Research Articles

Minimally invasive transvaginal single-port laparoscopic vesicovaginal fistula repair: a case report and the point of this technique.

The optimal surgical method of vesicovaginal fistula (VVF) remains uncertain. Minimally invasive surgical approaches have become highly popular in line with technological advancements, namely, laparoscopic, robotic, and transvaginal techniques. However, these techniques still require invasiveness. This is the first case report that described a novel "zero-incision" technique for natural orifice transvaginal single-port laparoscopy used to repair a recurrent and high-position VVF. The patient underwent transvaginal single-port laparoscopic repair of a VVF. Methylene blue was used to locate the VVF, and a needle electrode was used to thoroughly remove the scar tissue of the VVF. In addition, this technique for transvaginal single-port laparoscopy provides more working space to expose and repair fistulas conveniently and adequately. One year after surgery, the patient remained asymptomatic and had no fistula recurrence. Minimally invasive transvaginal single-port laparoscopy provides a clear surgical field, is safe and feasible. This novel technique has promising as an additional personalized treatment option for VVF repair.

The feasibility and outcome of laparoscopic vesicovaginal fistula repair as a minimally invasive technique: a retrospective descriptive monocentric study

vesicovaginal fistula (VVF) is the most common type of urogenital fistula. The laparoscopic approach to VVF repair offers the advantage of minimally invasive surgery with similar principles to the open trans-abdominal approach. The purpose of our study was to evaluate the transperitoneal laparoscopic approach as a minimally invasive tool for VVF repair. this was a retrospective study including 14 patients with VVF who underwent transperitoneal laparoscopic fistula repair between 2016 and 2020 in the urology department of the university hospital, Kairouan. Patients had undergone surgery at least six months after their primary gynecological surgery and were followed during 9 months after laparoscopic fistula repair. Data regarding patients' characteristics, operative data, and outcomes were gathered. The main outcome was the success rate of VVF closing and postoperative complications. fourteen patients were included. The patient's mean age was 34.8±8.2years. Size of fistula varied from 0.5 to 2cm and all the VVF were supratrigonal. The mean operative time was 145±23.4 minutes with no significant blood loss. The mean hospital stay was 4±1.4 days without major complications. Regarding analgesia, paracetamol was used for the first two days to meet the analgesia needs of all patients, and morphine was used in three cases (21.4%). During follow-up, two patients were re-operated for early recurrence (14.2%) and the total success rate was 85.7% (12 patients). the laparoscopic repair of VVF is a safe, effective, minimally invasive procedure, and without major complications.

Post Hysterectomy Vesicovaginal Fistula Repair Without Vaginal Vault Closure - A Simple Laparoscopic Extravesical Repair Approach

Purpose: The purpose of this study is to describe a simple extravesical laparoscopic approach for supratrigonal vesicovaginal fistula (VVF) repair without cystotomy and closer of the vaginal vault. Materials and Methods: This retrospective observational study reviewed data of 36 patients from January 2015 to January 2020. In our technique, the fistula tract was identified without cystotomy with the help of preplaced ureteric catheter in VVF tract. After meticulous extravesical dissection of the fistula tract, the bladder wall was closed in a single layer using polyglactin 2.0 sutures. The omental flap was approximated over the vaginal vault without primary closer of the vault. Results: In most of the patients the fistula opening were located 2 cm away from ureteric orifice while in 4 patients it located within 2 cm of orifice. The mean operative time was 86 min (65–125) and estimated blood loss was 94 ml (40–130). The mean size of fistula was 7.1 mm (5–15 mm). Omental flap was approximate over vaginal opening in most of the patients. The average hospital stay of patients was 5 days. In all patients, Foley catheter was removed on day 14 after cystogram. The mean follow-up of patients was 4.2 months (3–7). All patients remained continent and symptom free during the follow-up periods. Conclusion: Our technique without suturing of the vaginal vault in laparoscopic VVF repair is safe in a simple supratrigonal fistula with good results and avoiding added suturing.

Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.

Interposing layer of fibrin glue: A new horizon in vesico-vaginal fistula repair.

In this study our idea is to compare the effectiveness of using interposing layer of fibrin glue to omental flap in reducing the failure of laparoscopic vesicovaginal fistula repair. Forty patients with fairly large vesicovaginal fistula were enrolled and divided in two groups of 20 each. We have used fibrin glue in one group and omental flap in the other group. Of 20 patients in fibrin glue group no failure was seen, while 5 patients out of 20 in omental flap group had failure. This result is statistically significant and hence use of fibrin glue to be considered during laparoscopic repair of vesicovaginal fistulas.

Nuestra experiencia tras la reparación laparoscópica de la fístula vesicovaginal

Antecedentes: La fístula vesicovaginal (FVV) tiene una incidencia de 30 000 a 130 000 casos por año, generalmente asociados con histerectomía abdominal, cáncer y radiación pélvica. Para el diagnóstico es necesario realizar vaginoscopia, cistoscopia y cistografía. La mejor oportunidad para obtener resultados favorables es en el primer intento quirúrgico.
 Objetivo: Reportar los resultados obtenidos en el abordaje laparoscópico de fístula vesicovaginal en nuestro centro hospitalario.
 Materiales y métodos: Estudio descriptivo, ambispectivo en pacientes con FVV sometidos a reparación laparoscópica desde marzo de 2016 hasta noviembre de 2019.
 Resultados: Se incluyeron 15 pacientes sometidas a reparación de FVV por laparoscopia, con una edad media de 46.2 años e IMC promedio de 30.1 kg/m2. Los comórbidos asociados más frecuentes se encontraron HAS seguido de Ca de endometrio, con el antecedente quirúrgico ginecológico en el 100% de las pacientes. Del total, 1 paciente presentó recurrencia;1 paciente presenta complicación Clavien-Dindo III (6.67%).
 Discusión: En nuestro estudio, el 93.33% de los casos fueron causados por una histerectomía. Se informó que el paciente que presentó recurrencia de FVV presentaba tejido fibrótico leve, ubicación supratrigonal y tamaño de fístula de 3 mm, contrario a lo informado en la literatura.
 Conclusión: La reparación videoasistida por laparoscopía de la fistula vesicovaginal en nuestro hospital se reportó como un procedimiento seguro, con una incidencia de éxito del 93.3% (14 pacientes) en la primera intervención. Se encontró, además que la presencia de un proceso fibrótico moderado pudiera condicionar mayor dificultad técnica, aunado al sangrado transquirúrgico >250 cc. y estancia hospitalaria >3 días.

Our experience with laparoscopic repair of the vesicovaginal fistula

Background: The incidence of vesicovaginal fistula ranges from 30,000 to 130,000 cases per year, and it is generally associated with abdominal hysterectomy, cancer, and pelvic radiation. Vaginoscopy, cystoscopy, and cystography are necessary for its diagnosis. The best opportunity for achieving favorable results is in the first surgical intervention.
 Objective: To report the results of laparoscopic vesicovaginal fistula repair at our hospital center.
 Materials and methods: A descriptive, ambispective study was conducted on patients with vesicovaginal fistula that underwent laparoscopic repair within the time frame of March 2016 to November 2019.
 Results: Fifteen patients that underwent laparoscopic vesicovaginal fistula repair were included. They had a mean age of 46.2 years and a mean BMI of 30.1 kg/m2. The most frequent comorbidity was high blood pressure, followed by endometrial cancer. All patients had a history of gynecologic surgery. One patient presented with recurrence and one patient had a Clavien-Dindo III complication (6.67%).
 Discussion: In our study, 93.33% of the cases were caused by hysterectomy. The patient that had vesicovaginal fistula recurrence presented with mild tissue fibrosis at the supratrigonal location, and a 3 mm fistula, contrary to that reported in the literature.
 Conclusion: Video-assisted laparoscopic repair at our hospital was shown to be a safe procedure, with a success rate of 93.3% (14 patients) in the first intervention. In addition to the presence of a moderate fibrotic process that could condition greater technical difficulty, intraoperative blood loss was >250 cc and hospital stay was >3 days.

2298 Immediate Laparoscopic Nontransvesical Repair with Omental Interposition for Vesicovaginal Fistula Developing after Total Laparoscopic Hysterectomy

Video Objective To investigate the safety and feasibility of laparoscopic management for vesicovaginal fistula developing after TLH. Setting Case study, University hospital in Korea. Interventions A 51-year-old Korean woman underwent of immediate laparoscopic management for vesicovaginal fistula developing after total laparoscopic hysterectomy. A 51-year-old Korean woman was referred to my department for having urinary leakage two weeks before. She underwent total laparoscopic hysterectomy due to heavy vaginal bleeding and leiomyoma four weeks ago. We performed a laparoscopic vesicovaginal fistula repair with omental interposition on November 8th, 2016. We encountered a large adhesion from prior surgery in the pelvic cavity, so performed adhesiolysis using a harmonic sheers. After adhesiolysis, I performed bilateral ureterolysis that continued to the posterior bladder until it reaches the vesicovaginal space, which is then sharply dissected laterally and distally until the fistula is encountered. A bulb syringe were used to mobilize the vaginal cuff so that the dissection of the vesico-vaginal space and mobilization of the vagina could be performed easily. After adequate dissection and resection of the fistula tract from both the vagina and the bladder, a double-layer closure using 3-0 Vicryl was placed in a interrupted suture to secure the bladder. After the first layer of closure, the bladder was retrograde filled with 300cc of sterile water. Then second layer was closed in the same manner. And a single-layer closure of the vagina using a 1-0 Vicryl was placed transvaginally. After omental interposiotion to the fistula site, the procedure was over. There were no serious intraoperative or postoperative complications. Conclusion Laparoscopic approach for vesicovaginal fistula is safe and feasible.

Laparoscopic transvesical vesicovaginal fistula repair with the least invasive way: Only three trocars and a limited posterior cystotomy

ObjectiveTwo conventional approaches for vesicovaginal fistula (VVF) repair are transabdominal repair for supratrigonal VVF and transvaginal approach for low lying fistulae. Laparoscopic surgery was introduced to duplicate the surgical steps of the transabdominal approach with reduction in morbidity. We report a series of patients treated with a modified laparoscopic technique which includes the use of only three trocars and a limited posterior cystotomy. MethodsWe retrospectively reviewed the data of eight patients who underwent laparoscopic VVF repair with our standardized technique from January 2015 to April 2018. Only cases with a supratrigonal fistula were included. We constantly used only three trocars. A limited 2 cm midline posterior cystotomy was performed using ultrasonic energy. A stay suture on a straight needle was passed percutaneously in the abdomen, then on either side of the cystotomy and finally was exteriorized to maintain countertraction. The cystotomy was extended downwards to include the fistula site. The fistula was dissected circumferentially to raise the bladder and vaginal flaps. The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically. ResultsMean operative time was 178±31.6 min and estimated blood loss was 60±18.7 mL. Flap interposition was performed in six cases. No intraoperative complications were recorded. Mean hospital stay was 2.25±0.89 days. During hospitalization two patients experienced postoperative complications (Clavien grade I). Mean follow-up was 20.9±11.1 months (6.0–39.0 months). All patients remained continent during the follow-up period. ConclusionsThis minimally invasive laparoscopic approach with only three trocars and limited posterior cystotomy provides excellent results with minimum morbidity.

Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free. Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.

A prospective evaluation of the outcomes of 3-D transperitoneal laparoscopic vesico-vaginal fistula repair with omental interposition: our experience.

A prospective evaluation of the outcomes of 3-D transperitoneal laparoscopic vesico-vaginal fistula repair with omental interposition: our experience.

38: Robotic assisted laparoscopic vesicovaginal fistula repair

The objective of this video is to present the surgical steps for a robotic assisted laparoscopic vesicovaginal fistula repair. In this video we present the steps of a robotic assisted laparoscopic vesicovaginal fistula repair, beginning with placement of ureteral stents as well as stenting the tract itself for improved identification during dissection. The steps of tract excision, dissection, and a tension free closure are illustrated. Various techniques for vesicovaginal fistula repair have been described, traditionally completed via a vaginal approach. However, in patients with limited vaginal access vesicovaginal fistula repair performed with robotic assistance is a reasonable alternative.

Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience

Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital.
 Method: A 31-year-old female presented with vesicovaginal fistula
 after cesarean section. Patient complained of urinary incontinence
 since 5 years ago. After a failed trial of conservative treatment with
 catheter drainage, a transperitoneal laparoscopic repair was performed.
 Initially, cystoscopy was performed to confirm the fistula location
 and for bilateral ureteric catheterization. A 4-port technique
 was performed with the patient in lithotomy position and slightly
 Trendelenburg. Without opening the bladder, the fistula tract was
 excised and the bladder was separated from the anterior vaginal
 wall. Both the bladder and vaginal walls were then closed separately
 using intracorporeal suturing, interposed with the omentum.
 Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery,
 and the patient was discharged on the second day with an indwelling
 catheter. Surgical wound showed good cosmetic result and no
 leakage was identified from cystogram after 2 weeks. The catheter
 was removed after 2 weeks.
 Conclusion: Laparoscopic transperitoneal repair of vesicovaginal
 fistula with omentum inteposition is feasible in Dr. Hasan Sadikin
 Hospital with good outcome, short hospital stay, and good cosmetic
 result.
 [Indones J Obstet Gynecol 2014; 4: 223-225]
 Keywords: laparoscopy, vesicovaginal fistula

Comparative analysis of outcome between laparoscopic versus open surgical repair for vesico-vaginal fistula.

ObjectiveVesicovaginal fistula (VVF) causes detrimental psychosomatic effects on a woman. It is repaired using open abdominal as well as laparoscopic approach. Here we compare a series of open versus laparoscopic VVF repairs done at a single centre.MethodsRetrospectively data of patients undergoing VVF repair in our department between January 2011 to December 2014 was analyzed. Patients who had a single, primary, simple VVF following a gynaecological surgery were included in the study. 26 patients met all the criteria. Out of these, thirteen patients had undergone a laparoscopic VVF repair (group 1) while thirteen had undergone an open transabdominal VVF repair (group 2).ResultsMean fistula size was 2.14±0.23 cm in group 1 and 2.18±0.30 cm in group 2, which was comparable. Mean blood loss was 58.69±6.48 mL in group 1 and 147.30±19.24 mL in group 2, which is statistically significant (P<0.0001). Mean hospital stay was 4 days in group 1 and 13 days in group 2 which is statistically significant (P<0.0001). The analgesic requirement (diclofenac) was 261.53±29.95 mg in group 1 and 617.30±34.43 mg in group 2, which is statistically significant (P<0.0001). Fistula repair was successful in all the patients in both the groups.ConclusionThe present study shows that laparoscopic VVF repair results in reduced patient morbidity and shorter hospital stay without compromising the results. So laparoscopic repair may be a more attractive treatment option for patients with post gynecology surgery VVF.

Editorial Comment

This case series of 10 vesicovaginal fistulas (VVFs) repaired with robotic-assisted laparoscopic approach is a small, single-center experience that demonstrates the safety and success of this procedure. The authors had a 100% success rate at 4-44 months of follow-up. Pure laparoscopic repair of VVF has been reported in the literature for 20 years, but this series used robotic technology to make the minimally invasive approach less daunting given the difficulty in suturing sometimes encountered with straight laparoscopy. Robot-assisted Laparoscopic Repair of Vesicovaginal Fistula: A Single-center ExperienceUrologyVol. 86Issue 2PreviewTo describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients. Full-Text PDF ReplyUrologyVol. 86Issue 2PreviewThe aim of this report is to share our experience in robot-assisted laparoscopic repair of vesicovaginal fistulas (VVFs). We report our surgical techniques in detail and outcomes over a reasonable length of follow-up. VVF repair is an uncommon procedure at our institution, and thus, we were only able to accrue 10 cases for robot-assisted repair over a 3-year period. The results we achieved however are encouraging and provide further evidence that the robotic platform can be used safely and successfully for VVF repair. Full-Text PDF

Robot-assisted Laparoscopic Repair of Vesicovaginal Fistula: A Single-center Experience

To describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients. From November 2010 to April 2014, a total of 10 patients with VVF underwent robot-assisted laparoscopic VVF repair. The principles of VVF repair were followed. The fistula tract was excised. The vagina defect and the cystotomy were closed with a flap of epiploica of sigmoid colon, a peritoneal inlay, or a bladder adventitia layer interposed between the bladder and vaginal suture lines. Perioperative patient characteristics, complications, operative data, and follow-up results were retrospectively reviewed with institutional review board approval. All 10 patients developed VVF as a result of previous elective hysterectomies for benign indications. Mean operative time was 214minutes (range, 120-457minutes). Longer operative times were caused by concomitant surgeries (3 ureteral reimplantations and 1 planned sigmoid colectomy). Median length of stay was 1day (range, 1-5days). There were no intraoperative complications. Perioperatively, there was 1 Clavien-Dindo grade 1 complication (ileus), and 2 grade 2 complications (readmission with Clostridium difficile infection and atelectasis). All patients were cured and were without VVF recurrence at a median follow-up close to 2years. Robot-assisted laparoscopic VVF repair is an effective approach to manage VVF even in complex medical scenarios. It is anticipated that an increasing number of VVF repairs will be undertaken with robot-assisted approach in the future, offering more patients who need VVF repair the advantages of minimally invasive surgery.

Laparoscopic transperitoneal approach for vesicovaginal repair : The first experience in Hasan Sadikin Hospital

Introduction : Obstetric fistula is a severe and debilitating condition occurring throughout the developing world. Although there are no accurate data on the incidence and prevalence of the condition, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with transperitoneal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Transperitoneal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair and omentum interposition. Objective : To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital. Patient and Method : A 31-year-old female presented with vesicovaginal fistula after sectio caersaeran. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic 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 position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. Result : Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operatif day 1 and patient was discharged on the second day with an indwelling catheter. Good cosmetic result on wound operation and no leakage under cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion : Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Hasan Sadikin Hospital with good outcomes, short hospital days, and good cosmetics result. Keywords : Fistula vesico vaginal, laparoscopic.

Laparoscopic and Robotic-assisted Vesicovaginal Fistula Repair: A Systematic Review of the Literature.

Two types of laparoscopic or robotic-assisted vesicovaginal fistula (VVF) repairs, the traditional transvesical (O'Conor) and extravesical techniques, dominate the literature. The objectives of this study are to compare success rates between laparoscopic or robotic transvesical and extravesical laparoscopic VVF repair techniques and to evaluate the impact of the number of layers in the closure, interposition flaps, and intraoperative testing of the integrity of the bladder repair. Eligible studies, published between 1994 and March 10, 2014, were retrieved through Medline and bibliography searches. All study designs of laparoscopic/robotic VVF repair were included. Open laparotomy and vaginal approaches were excluded. Only 1 retrospective cohort study was included, with the remaining articles consisting of case reports and case series. Ultimately, only 44 studies were included in a systematic review: 9 articles of robotic-assisted approach, 3 laparoscopic single-site surgeries, and 32 conventional laparoscopic approaches. A literature review revealed a balanced number of reports for both transvesical and extravesical approaches. Statistical meta-analysis was not performed because of high heterogeneity. The overall success rate of laparoscopic VVF repair was 80% to 100% with a follow-up period of 1 to 74 months. The success rate of transvesical and extravesical techniques were 95.89% and 98.04% (relative risk, .98; 95% confidence interval, .94-1.02). There was no statistical difference in success rates of VVF repair with different number of layers in the fistula closure or with use of interposition flaps, but there was a small increase in success in the cases that documented intraoperative bladder filling to test the integrity of the bladder closure. In conclusion, transperitoneal extravesical VVF repair has cure rates similar to the traditional transvesical approach. Laparoscopic extravesical VVF repair is a safe, effective, minimally invasive technique with excellent cure rates similar to those of the conventional transvesical approach in experienced surgeons' hands.

Experience of laparoscopic repair in 5 patients with vesicovaginal fistula

To explore new methods for laparoscopic repair of vesicovaginal fistula. Five patients with vesicovaginal fistula in Xiangya Hospital, Central South University, were reviewed retrospectively from May 2013 to July 2014. All patients underwent laparoscopic repair surgery, and the surgical methods were analyzed. The operative time, intraoperative blood loss, and hospital stay time were recorded. The duration of follow-up was from 4 to 12 months. Th e surgical procedures for all 5 patients were successful. No open surgery was required. The operative time was 70~120 (mean: 97) min, the intraoperative blood loss was 40~70 (mean: 54) mL, the hospital stay time was 4~8 (mean: 5.8) days. During the follow up of 4~12 (mean: 7.6) months, no recurrence was observed. Laparoscopic repair of vesicovaginal fistula is a feasible and safe and effective procedure with less blood loss and shorter recovery time, which can minimize surgery damage and improve successful rate.

Laparoscopic Transperitoneal Approach for Vesicovaginal Repair : The First Experience in Hasan Sadikin Hospital

&#x0D; &#x0D; &#x0D; Background. Obstetric fistula is a severe and debilitating condition occurring throughout the developing world. Although there are no accurate data on the incidence and prevalence of the condition, the majority of vesicovaginal fistulas develop after obstetric procedure, with delayed labour accounting for 90% of cases. Several techniques are available for repairing the fistulas. Transperitoneal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair and omentum interposition. The objective of this article is to report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital.&#x0D; Method. A 31–year–old female presented with vesicovaginal fistula after sectio caersaeran because of de- layed labour. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilat- eral ureteric catheterization. A 4–port technique was performed with the patient in the position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum.&#x0D; Results. Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operative day 1 and patient was discharged on the second day with an indwelling catheter. Food cosmetic result on wound operation and no leakage under cystogram after 2 weeks. The catheter was removed after 2 weeks.&#x0D; Conclusion. Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Hasan Sadikin Hospital with good outcomes, short hospital days, and good cosmetics result. Still need more same cases before a final conclusion&#x0D; &#x0D; &#x0D;