Malignant Fistula Research Articles

Early bladder dysfunction after vesicovaginal fistula repair: A prospective comparative analysis of transvaginal, open, and laparoscopic abdominal approaches.

We aim to compare the clinical and urodynamic profile oflower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period. Fifty-one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation-induced, and complex fistulae were excluded after cross-sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed theAmerican Urological Association Symptom Score questionnaire and underwent a dual channel pressure-flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared. All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty-two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty-six patients reported some LUTS at a median follow-up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty-seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients. In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction.

Prediction of malignant esophageal fistula in esophageal cancer using a radiomics-clinical nomogram

BackgroundMalignant esophageal fistula (MEF), which occurs in 5% to 15% of esophageal cancer (EC) patients, has a poor prognosis. Accurate identification of esophageal cancer patients at high risk of MEF is challenging. The goal of this study was to build and validate a model to predict the occurrence of esophageal fistula in EC patients.MethodsThis study retrospectively enrolled 122 esophageal cancer patients treated by chemotherapy or chemoradiotherapy (53 with fistula, 69 without), and all patients were randomly assigned to a training (n = 86) and a validation (n = 36) cohort. Radiomic features were extracted from pre-treatment CTs, clinically predictors were identified by logistic regression analysis. Lasso regression model was used for feature selection, and radiomics signature building. Multivariable logistic regression analysis was used to develop the clinical nomogram, radiomics-clinical nomogram and radiomics prediction model. The models were validated and compared by discrimination, calibration, reclassification, and clinical benefit.ResultsThe radiomic signature consisting of ten selected features, was significantly associated with esophageal fistula (P = 0.001). Radiomics-clinical nomogram was created by two predictors including radiomics signature and stenosis, which was identified by logistic regression analysis. The model showed good discrimination with an AUC = 0.782 (95% CI 0.684–0.8796) in the training set and 0.867 (95% CI 0.7461–0.987) in the validation set, with an AIC = 101.1, and good calibration. When compared to the clinical prediction model, the radiomics-clinical nomogram improved NRI by 0.236 (95% CI 0.153, 0.614) and IDI by 0.125 (95% CI 0.040, 0.210), P = 0.004.ConclusionWe developed and validated the first radiomics-clinical nomogram for malignant esophageal fistula, which could assist clinicians in identifying patients at high risk of MEF.

Palliation of malignant esophageal stent esophagorespiratory fistula with rigid bronchoscope and Y silicone trachea stent: experience with seven patients.

Malignant esophageal stent esophagorespiratory fistula (ERF) is an abnormal communication between esophagus and airway among advanced tumor patients with indwelling esophageal stent, which is devastating and life-threatening. This study aims to provide a new feasible treatment scheme for malignant esophageal stent ERF and report its potential advantage compared with double stenting, which was recommended by European Society of Gastrointestinal Endoscopy Guideline. We retrospectively analyzed the medical data of malignant esophageal stent ERF patients between January 2018 to May 2023 at the First Affiliated Hospital of Guangzhou Medical University and divided them into two groups. Group 1 consisted of patients treated with rigid bronchoscopy to remove the esophageal stent and implant Y silicone trachea stent, while group 2 consisted of patients treated with additional airway stenting without removing the esophageal stent. Demographic parameters, disease diagnoses and treatment, radiological findings before and after the intervention, and complications caused by the stents were obtained and analyzed with chi-squared, Mann-Whitney U, independent-samples t-tests, Kaplan-Meier methods, and log-rank test. Ten patients (seven patients in group 1 and three in group 2) were included. No procedure complications occurred in both groups. The mean Karnofsky Performance Score after the procedure significantly improved compared to the pre-procedure (57.14 vs. 77.14, P=0.001) in group 1, while decreased in group 2 (50 vs. 40, P=0.026). The control of pneumonia in group 1 patients is better than that in group 2. There was significant improvement in the degree of dysphagia after the procedure (3.86 vs. 2.43, P=0.002) in group 1, while no improvement was found in group 2 (4.00 vs. 3.33, P=0.423). The mean survival of group 1 was significantly longer group 2 (381.00 vs. 80.33 days, P<0.001, log-rank test). No patient needed stent repositioning due to migration in both groups. Cause of death in the group 1 included disease progression, novel coronavirus pneumonia, massive hemoptysis, and respiratory insufficiency, while group 2 included severe pneumonia and disease progression. No death was directly attributed to the procedure in both groups. Removing the esophageal stent and implanting Y silicone trachea stent through a rigid bronchoscopy is a safe and feasible treatment for malignant esophageal stent ERF. This procedure can effectively seal the fistula, prevent from recurrent aspiration pneumonia, improve the quality of life, and prolong the survival time.

Enigma of Esophageal - Respiratory Fistula in Advanced Esophageal Cancer

Background: The incidence of malignant esophageal-respiratory fistulas in esophageal cancer patients is not so frequent. The fistula development in esophageal cancer may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of esophageal-respiratory fistula; one with esophageal bronchial fistula and the other with esophageal pleural fistula.&#x0D; Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an esophageal growth of 8.5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. Nine months after the start of treatment, the patient’s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an esophageal-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an esophageal growth of 5.5 cm in the middle esophagus. The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’s dysphagia worsened; barium swallow showed esophageal-bronchial fistula. The patient was managed symptomatically and later lost to follow-up.&#x0D; Conclusions: Fistula formation and subsequent abscess results in a poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes esophageal-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.

Successful Treatment of Double Malignant Fistulas in Advanced Rectosigmoid Junction Tumor with Neoadjuvant Chemoradiation and Surgery: A Case Report

This case report describes a successful treatment of rare double malignant fistulas in an advanced rectosigmoid junction tumor using neoadjuvant chemoradiation and surgery. An 81-year-old woman presented with poor appetite, abdominal fullness, dizziness, and bloody stool. She was diagnosed with an advanced rectosigmoid junction tumor with double malignant fistulas (ceco-sigmoid and ileo-sigmoid fistulas). The patient received neoadjuvant chemoradiation therapy followed by surgical resection of the tumor and the fistulas. The patient’s postoperative recovery was uneventful. Her pathological examination showed a partial pathological response to the neoadjuvant therapy. The patient had no evidence of local recurrence or distant metastasis at her 1-year follow-up. This case demonstrates the importance of a multidisciplinary approach in managing complex cases and suggests that neoadjuvant chemoradiation therapy combined with surgery may be an effective treatment for advanced rectosigmoid junction tumors with double malignant fistulas.

Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report

BackgroundA colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.Case presentationA 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient’s physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.ConclusionsA covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.

Efficacy and Safety of Self-Expandable Metallic Stent Placement for Malignant Esophageal Fistula.

Patients with malignant esophageal fistulas often experience dysphagia and infection, resulting in poor prognoses. Self-expandable metallic stent (SEMS) placement is a palliative treatment option; however, its efficacy and safety are unclear. We aimed to determine the efficacy and safety of SEMS placement for malignant esophageal fistulas. We retrospectively investigated patients who underwent SEMS placement for malignant esophageal fistulas between 2013 and 2022 at the Cancer Institute Hospital. Dysphagia scores (DSs) before and after SEMS placement, adverse events, and overall survival from SEMS placement until death were evaluated. A total of 17 patients underwent SEMS placement, including 12 and 5 patients with esophageal and lung cancers, respectively. Prior treatments included chemoradiotherapy (n = 11), radiotherapy (n = 4), and chemotherapy (n = 4); two patients underwent palliative radiotherapy after chemotherapy. All procedures were technically successful. After SEMS placement, 14 (82.4%) patients were able to consume semisolid or solid food (DS ≤ 2). Major adverse events were encountered in only one case. The median survival time after SEMS placement was 71 days (range 17-247 days). SEMS placement allowed most patients to resume oral intake with a low rate of major adverse events. SEMS placement is a reasonable palliative treatment option for patients with malignant fistulas who have poor prognoses.

Management of a malignant esophagopleural fistula after stent failure with a suturing pexy: time to seal the leak.

Video 1Suturing pexy to seal a leak around an esophageal stent in the setting of a malignant esophago-pleural fistula.

Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.

Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.

Duodenal stenting as a palliative approach to a malignant duodenocolonic fistula

Video 1Duodenocolonic stenting video.

GASTROINTESTINAL BLEEDING DUE TO A MALIGNANT COLODUODENAL FISTULA: CASE REPORT AND LITERATURE REVIEW

Background: Coloduodenal fistulas are a rare occurrence seen in 0.1% to 0.14% of colon cancer patients. Malignant coloduodenal fistulas are associated with poor prognosis given presence of locally advanced, and often times metastatic disease at the time of diagnosis. Patients can present with abdominal pain, vomiting and occasionally, bleeding. Intractable symptoms, obstruction and bleeding are indications for operative intervention. Surgical management can vary depending on the extent of duodenal involvement; from sleeve or segmental resection of the duodenum to pancreaticoduodenectomy. We describe a patient that underwent a right hemicolectomy and pancreaticoduodenectomy for a bleeding malignant coloduodenal fistula.

THE NONCOMPLIANT PATIENT WITH THE BROKEN STENT

THE NONCOMPLIANT PATIENT WITH THE BROKEN STENT

S2068 Malignant Colo-Duodenal Fistula in a Rare Anatomic Position

Introduction: The first case of malignant colo-duodenal fistula (MCDF) was reported in 1862 and since then only 70 MCDF cases had been reported. We describe a case of MCDF between the hepatic flexure and second part of the duodenum, a rarely observed anatomic location. Case Description/Methods: A 63-year-old male presented to an outside hospital with lethargy and a weight loss of 30 lbs over 3 months without any overt GI bleed and was found to be anemic. He had RUQ rebound tenderness and a positive stool occult blood test. A large duodenal ulcer was found on EGD that was concerning for malignancy. He was subsequently transferred to our hospital for further evaluation. CT abdomen showed a contrast-filled fistulous communication with associated circumferential wall thickening and luminal narrowing between the duodenum and the colon. Scattered noncalcified pulmonary nodules in both lungs were also observed. A repeat EGD showed a large, partially circumferential, friable ulcer in the first part of the duodenum with a fistulous tract connecting to the colon. A colonoscopy showed a fistulous tract with surrounding ulceration and adenomatous-appearing mucosa in the hepatic flexure of the colon connecting to the duodenum. The endoscope could not be advanced safely beyond the hepatic flexure due to edema around the fistulous tract. Pathology revealed invasive moderately differentiated adenocarcinoma with ulceration and detached fragments of small intestinal and colonic mucosa in the duodenal biopsies and invasive moderately differentiated adenocarcinoma with cells that were CK20+, SATB2+, and CK7− consistent with metastatic colorectal cancer in the colon biopsies. Surgical and medical oncology were consulted for management (Figure 1). Discussion: Most MCDF involve the second portion of the duodenum. In our patient, the fistula connected the first portion of the duodenum to the hepatic flexure of the colon. Although, 20% of hepatic flexure tumors are adherent to the duodenum, very few fistulate into it. Cross-sectional imaging with contrast studies help confirm and stage the primary tumor and fistulous tract by delineating extent of local invasion and evaluating for metastatic spread. Upper and lower endoscopy help demonstrate the fistulous communication and biopsy allows for a pathological diagnosis. Definitive treatment involves a surgical resection of the primary malignancy. However, but once the disease has progressed to point of fistulization or metastases, the overall prognosis is poor.Figure 1.: A, CT Abdomen with contrast showing colo-duodenal fistula (red arrow) B, EGD showing fistula in 2nd part of the duodenum (black arrow) and ulceration. C, Colonoscopy showing fistula (green arrow) in the hepatic flexure with ulceration and edema.

Malignant duodenocolic fistula successfully treated with self-expandable partially covered metal stent and endoscopic suturing.

Malignant duodenocolic fistula successfully treated with self-expandable partially covered metal stent and endoscopic suturing.

Radiation Therapy and Malignant Fistulae of Anorectal Cancers

PurposeAlthough fistulization is a well-studied late toxic effect of radiation therapy (RT), anorectal cancers (ARCs) can present with malignant fistulae (MF) and negatively affect quality of life. The effect of RT, often combined with concurrent chemotherapy, on MF needs systematic analysis, because practitioners are concerned that RT may exacerbate MF. We reviewed our institutional series evaluating the hypothesis that RT worsens MF. Methods and MaterialsA single-institutional retrospective analysis of patients with ARC receiving RT from 2006 to 2019 was performed. These patients were screened for MF. Any MF resected before RT and RT not directed at the site of MF were excluded. Effects were assessed by review of available follow-up documentation and imaging. ResultsA total of 639 patients with ARC were reviewed, and 47 had MF (7.4%). With a median follow-up of 22 months (range, 2-133 months), RT improved MF in 17 of 29 evaluable patients (59%), with 9 of 29 (31.0%) having resolution. The median time to improvement was 50 days (range, 25-117 days); the median duration of improvement was 161 days (range, 0-1941 days). Malignant fistulae persisted in 12 of 29 patients (41%), with persistent local disease in all cases; in 2 cases, MF worsened concomitant with local progression. ConclusionsIn all, 7.4% of patients with ARC presented with MF. Radiation therapy led to improvement or resolution in more than half of evaluable patients. Persistence or worsening of MF was only observed in patients with refractory or progressive local disease. Based on our findings, MF is not a contraindication to RT and may be considered as an independent indication for palliative RT.

Use of airway stents to treat malignant tracheobronchial fistulas: Our six-year experience.

Background This study aims to investigate the indications, safety, complications, and long-term outcomes of airway stenting in the treatment of malignant tracheobronchial fistulas. Methods The medical records of a total of 34 patients (24 males, 10 females; mean age: 55.4+13 years; range, 23 to 76 years) with malignant tracheobronchial fistulas treated with airway stenting between February 2014 and August 2020 were retrospectively analyzed. Data including demographic features, diagnosis, symptoms, treatment, complications and outcomes were recorded. Results Thirty-eight airway stents were inserted in 34 patients with malignant tracheobronchial fistulas, including 19 patients with malignant tracheobronchial esophageal fistulas and 15 patients with bronchopleural fistulas. The clinical success and the technical success rates were 91% and 100%, respectively. No perioperative death or severe complications occurred. Chronic complications (>24 h) occurred in eight (23%) patients with malignant tracheobronchial fistula. Median follow-up was 3.5 (range, 1.4 to 5.5) months in patients with malignant tracheobronchial esophageal fistulas and 18 (range, 9.5 to 26.5) months in patients with bronchopleural fistulas. Mortality rates were 79% and 61%, respectively. Conclusion Airway stent insertion provides a secure and effective treatment for patients with malignant tracheobronchial fistulas.

Malignant duodenocolic fistula as a form of presentation of right colon cancer. Case report

Malignant duodenocolic fistula in an unusual presentation internal fistula, whose main symptoms are abdominal pain, weight loss, halitosis, fecaloid vomiting and diarrhea. We report the case of a 79-year-old patient with diarrhea, fecaloid vomiting and significant weight loss, who is surgically intervened with the diagnosis of duodenocolic fistula, performing right hemicolectomy, partial duodenectomy, transverse duodenorphy as definitive treatment.

Safety and Efficacy of Self-Expandable Metallic Stent Placement Using Low Radial Force Stent for Malignant Dysphagia after Radiotherapy

Introduction: We aimed to investigate the safety and efficacy of self-expandable metallic stent (SEMS) placement in patients with prior radiotherapy (RT) using the Niti-S stent, which is characterized by low radial force, in comparison to patients without prior RT. Methods: A consecutive series of 83 patients who were treated by SEMS placement using Niti-S stent for severe malignant esophageal obstruction or fistula were enrolled. The adverse event rates and efficacy were retrospectively compared between patients with/without prior RT before SEMS placement (RT group [n = 32] versus non-RT group [n = 51]). Results: The incidence rate of major adverse events in the RT group was 6.3% and was not significantly different from that in the non-RT group (5.9%, p = 0.95). Among the RT group, 84.4% were able to resume oral intake within a median of 2 days. Among the patients with fistula, 78.6% could resume oral intake and survive for 73 days after SEMS placement. Cox proportional hazard regression analysis identified significant factors affecting overall survival to be prior RT (hazard ratio [HR]: 1.96), low performance status (HR: 3.87), and subsequent anticancer treatment after SEMS placement (HR: 0.41). However, compared to the non-RT group, the RT group had received longer duration of anticancer treatment before SEMS placement and a lower rate of subsequent anticancer treatment after SEMS placement. Conclusions: With the Niti-S stent, the incidence of major adverse events was sufficiently low even for patients after RT. SEMS with low radial force would be an effective palliative treatment option for patients, regardless of prior RT.

MALIGNANT DUODENOCOLIC FISTULA- CASE REPORT OF RARE COMPLICATION OF COLONIC CANCER TREATED BY MULTIVISCERAL RESECTION

Duodenocolic fistulas created by invasive cancer of the colon are rare complications. They are presented with serious electrolytic and nutritional disturbances due to vomiting, diarrhoea, abdominal pain, GI bleeding, and weight loss.&nbsp;Case report: In this paper we present young male patient with malignant duodenocolic fistula between ascendant colon and D2 portion of duodenum and pancreatic head, treated with right hemicolectomy and pancreaticoduoedenectomy. Postoperative histopathology confirmed poorly differentiated colonic adenocarcinoma without spreading to lymph nodes and major vessels. Patient is still alive after three years of the operation which led as to conclusion that this type of radical operation may represent one of the best treatments for this rare complication, provides good quality of life and is prognostically justifiable. Keywords: malignant duodenocolic fistula, advanced colorectal carcinoma (CRC), right hemicolectomy, pancreaticoduoedenectomy.

Prospective Study on Clinical Outcomes of Laparoscopic Repair of Vesicovaginal Fistula with V-Loc 90 Suture

1.1. Objective To study feasibility , efficacy and postoperative outcomes of laparoscopic vesicovaginal repair with barbed, resorbable 3-0 V-Loc 90 sutures. 1.2. Methods Patients presented with vesicovaginal fistula and failed with more than 3 weeks of bladder drainage using a foley catheter are selected for study. The cases where the fistula can be approached via vaginal route adequately without episiotomy or moderate to heavy traction, recurrent cases, complex fistulas , post radiation and malignant fistula are excluded from this study. 1.3. Results In our study from March 2019 to November 2021, total 15 patients were enlisted for laparoscopic VVF repair using V-Loc suture. The main objective of laparoscopic repair of VVF is rapid cessation of urinary leakage with early return of normal and complete urinary and genital function. The most common cause of VVF in our studies was hysterectomy 12 (80%), caesarean section 3 cases (20%) . In our study in all cases laparoscopic transperitoneal transvesical mini-O’ Conor approach with an interposition of omental graft or appendices epiploicae were adopted. In our study all fistulas were supratrigonal with average size of 1.8 cm (range 0.8 to 3.4 cm). Mean age of patients undergoing VVF repair was 39.9 years (range 26 to 48years) . Estimated blood loss was 63 ml (range 30 ml to 160 ml) , and mean operative time 130 minutes (range 100 to 190 minutes). There was no serious intraoperative or postoperative complications including: conversion to open procedure, denying operative procedure, vascular, bowel or ureteric injury, blood transfusion, blood clots, pulmonary embolism, cardiac events or strokes. Length of hospital stay was mean 5.2 days (range 3 to 8 days). Patients were instructed to return our outpatient department 14 to 21 days after surgery for cystogram, cystoscopic and vaginal inspection to confirm successful VVF repair and subsequent suprapubic catheter removal. At a mean of 14.7 months (range 6 to 37 months) no recurrence of VVF occurred with success rate is 100% (15 out of 15 patients). 1.4. Conclusions In the era of minimally invasive surgery, it is difficult to deny its role in the management of VVF. It can be performed safely and effectively with shorter operative time. It seems to offer patients a shorter hospital stay, less morbidity , quicker convalescence, better cosmesis and equal efficacy. Technically, laparoscopy provides better visualization through magnification, but is more difficult to learn, as is intracorporeal suturing. Use of resorbable continuous barbed sutures (V-Loc) simplify the technique and reduce the time of surgery while avoiding implementation of knots. Successful treatment using a laparoscopic approach in VVF is highly dependent on the surgeon’s experience, tissue conditions around fistulae, tension-free watertight closure, and adequate postoperative urinary drainage