Purse-string Suture Research Articles

Comparison of purse string suture versus transverse mattress suture to secure haemostasis in thinned out caesarean section scars.

Objective: To compare the effectiveness of two types of haemostatic sutures to secure bleeding in thinned out caesarean section scars. Study Design: Comparative Interventional Study. Setting: CMH Okara, Pakistan. Period: September 2019 to September 2021. Material & Methods: Patients were divided in four categories. Category I was previous one scar patients while category II was previous two scars patients. Similarly, categories III and IV were previous three and four scar patients respectively. In each category hemostasis was secured either by purse string suture or transverse mattress sutures. Hemostasis whether achieved with difficultly or without difficulty was assessed and time utilized was also calculated. Results: In patients with previous one caesarean section 3 out of 15 (20%) had haemostatic difficulty with both purse string suture and horizontal mattress suture. In patients with previous two caesarean sections the number was 5 (33.33%) and 6 (40%) in both purse string and horizontal mattress suture respectively. In patients with previous three caesarean sections there were 7 (46.66%) women who had difficulty in haemostasis in both group I and II. The average time to achieve the procedure in group I (purse string suture) was 3.25 minutes while it was 7.5 minutes in group II (Horizontal mattress sutures). There was two times difference in time consumption between two groups. Conclusion: Purse string suture is more effective, convenient and quicker to apply as compared to transverse mattress sutures for haemostasis in thinned caesarean section scars.

Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations.

Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS). To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS. This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS (n = 63) or C-EPSS (n = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis. Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% vs 17%) and a much shorter procedure time (9.06 ± 6.14 min vs 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% vs 4%; P = 0.82) and delayed bleeding (3% vs 4%; P = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; P < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; P = 0.039) showed a statistical tendency to result in an increase in delayed adverse events. The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

BackgroundThe recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model.MethodsIn the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure.ResultsThe mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 s in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone.ConclusionThe OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.

A Peritoneal Purse-String Suture Prevents Symptomatic Lymphoceles in Retzius-Sparing Robot-Assisted Radical Prostatectomy.

The retzius-sparing approach for robotic-assisted radical prostatectomy (RARP) has been increasingly adopted. Symptomatic lymphoceles are a widespread complication of RARP with pelvic lymph node dissection. Here, we present a new technique, the peritoneal purse-string suture (PPSS), that seems to reduce the rate of symptomatic lymphoceles following retzius-sparing RARP with extended pelvic lymph node dissection (ePLND). The radical prostatectomy and bilateral lymphadenectomy are performed through three separate peritoneal openings. The PPSS uses a single suture in a way similar to a purse-string suture; the openings of both lymphadenectomy fields are widened, and the rectovesical opening from the prostatectomy is simultaneously closed. This report retrospectively evaluates the perioperative and postoperative outcomes of two consecutive patient cohorts undergoing RARP with ePLND by a single surgeon between May 2015 and June 2019, one cohort prior to introducing PPSS as control (n = 145) and the other after introducing PPSS (n = 91). The two study groups were comparable on baseline characteristics, except ASA. There were no Clavien-Dindo grade IV-V complications, and comparable rates of grade I-III complications. The difference in postoperative lymphocele formation was 22% in PPSS versus 27% in the control group (p = 0.33). The rate of symptomatic lymphoceles was significantly lower in the PPSS group (3% vs. 10%, p = 0.047). The PPSS is a feasible procedure that reduces symptomatic lymphoceles in patients undergoing RARP with a retzius-sparing approach.

Prefixed purse-string suture used as a new approach to resect a submucosal tumor in the ileocecal region.

Prefixed purse-string suture used as a new approach to resect a submucosal tumor in the ileocecal region.

Modified linear closure with standing cone management: An alternative to the purse string suture

Modified linear closure with standing cone management: An alternative to the purse string suture

Single-stapling technique versus hand-sewn anastomosis in inter-sphincteric resection with transanal total mesorectal excision (Super SST): protocol for a multicentre randomized clinical trial

Currently, hand-sewn anastomosis is the standard procedure for inter-sphincteric resection (ISR); however, distal purse-string suturing during transanal total mesorectal excision (TaTME) has allowed a single-stapling technique (SST). Although it was originally intended for cases requiring anastomosis of 2 cm or more above the anorectal junction (ARJ), SST could be safely performed in ISR. The aim of this trial is to determine the superiority of SST over hand-sewn anastomosis in ISR with TaTME. The Super SST trial is a multicentre randomized clinical trial comparing stapled and hand-sewn anastomoses in ISR with TaTME. The trial will recruit patients scheduled for TaTME with anastomosis below the ARJ, who will be allocated 1:1 to receive either hand-sewn or stapled anastomosis. The primary endpoint is anastomosis-related complications within 30 postoperative days. Secondary endpoints include all early and late complications, operating time, reoperation, mortality rate, length of postoperative hospital stay, readmission, incidence of anal pain and rectal mucosal prolapse, length of temporary stoma retention, the proportion of patients with a temporary stoma at 1 year after surgery, and anorectal function at 1 year after surgery. This trial will provide important clinical insights for new and promising anastomotic options for patients with very low rectal cancer. Registration number: UMIN000047818 (https://www.umin.ac.jp/ctr/index-j.htme).

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

ObjectiveTo investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment.MethodsThe data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People’s Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications.ResultsThere were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05).ConclusionPurse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients’ appendiceal stumps were treated with laparoscopic purse-string sutures.

Various Applications of Purse-String Suture and Its Cosmetic Outcome in Cutaneous Surgical Defects.

Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest follow-up visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.

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Digestive EndoscopyVolume 35, Issue 2 p. i-i Cover ImageFree Access Cover Image First published: 19 January 2023 https://doi.org/10.1111/den.14358AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Graphical Abstract Cover image: Endoscopic full-thickness resection of a gastric gastrointestinal stromal tumor (GIST). (a) A 30 mm, intraluminal type submucosal tumor at the greater curvature of the upper body is diagnosed as GIST by boring biopsy. (b) After mucosal incision and slight submucosal dissection, a clip with line is attached to the specimen for easy dissection and for preventing the tumor from extending beyond the stomach. (c) En bloc resection is achieved, and abdominal fat is identified from the perforation site. (d) The defect is closed with a purse-string suture. (e) The defect is closed completely. (f) The tumor is retrieved piecemeal. (g) Sectioning after fixation of all the specimens. (h) Spindle-shaped tumor cells proliferate in an intricate fascicle, with positive c-kit, leading to the diagnosis of GIST. (See Shichijo et al. p. 209). Volume35, Issue2Special Issue: Transluminal Endoscopy and Endoscopic Full-thickness ResectionJanuary 2023Pages i-i RelatedInformation

Partial Purse String Suture with Delayed Reconstruction for a Large Defect Abutting a Free Margin.

Partial Purse String Suture with Delayed Reconstruction for a Large Defect Abutting a Free Margin.

Gastric schwannoma diagnosing gastric stromal tumor.

A 45-year-old male visited our hospital for a medical examination without any clinical complaints. The patient had an gastroscopy, which revealed a 30mm*30mm hemispherical submucosal tumor arising from the lesser curvature of the gastric body , suggesting a gastrointestinal stromal tumor (GIST) as a preoperative diagnosis;Endoscopic resection was determined to be the best choice and the patient underwent a endoscopic full-thickness resection and endoscopic purse-string suture. Except for a slight low fever, the patient was well recovered and was discharged on his 7th post-operation. Pathological analysis and immunohistochemical staining showed fascicular growth of neoplastic Schwann cells and confirmed the diagnosis of gastric schwannoma through high positivity for S-100 protein.

Breaking boundaries: laparoscopic and endoscopic collaboration in appendectomy.

Background The combination of endoscopy and laparoscopic assistance is gaining attention due to its minimally invasive approach and the potential to improve the safety of surgical treatment for potential malignant tumors at the base of the appendix. Methods Initially, we attempted an endoscopic resection for a patient with a large adenoma in the ileocecal region, with involvement of the appendiceal orifice. However, due to intraabdominal adhesions, a smooth resection was not possible. Therefore, in collaboration with the surgical team, we proceeded with the laparoscopic release of adhesions followed by endoscopic appendectomy. The surgical site was closed using endoscopic purse-string sutures, and intestinal and intraperitoneal dual drainage tubes were placed. Results The patient had a favorable recovery following the appendectomy, with no adverse complications. One year later, the follow-up endoscopy revealed excellent closure of the surgical site. Conclusions The integration of internal medicine and surgery has become an inevitable trend in the advancement of medical disciplines. The laparoscopic and endoscopic combined surgery enhances the cooperation between internal medicine and surgery, ultimately benefiting the patients. This significant attempt holds the promise of further supplementation and support from additional clinical data.

Development of Magnetic Anastomat for Laparoscopic Bilioenterostomy

This work introduces the design and operating procedure of a novel magnetic anastomat for laparoscopic bilioenterostomy. Three techniques (magnetic compression technique, mechanic control technique and purse string suture technique) are used to design this device. The anastomat is mainly composed of two parts, a magnetic head and a handle. The surgical procedure for laparoscopic bilioenterostomy with this novel anastomat is similar to performing an end-side enteroenterostomy with the circular stapler. After the anastomosis is achieved, the magnetic head is placed at the anastomoses to maintain the digestive tract continuity. The magnetic head would fall into the jejunal lumen when the anastomoses is formed. This surgical approach would bring an innovation to the laparoscopic bilioenterostomy. Performing laparoscopic bilioenterostomy with this magnetic anastomat is safe, reliable and feasible.

Suprasternal transcatheter aortic valve replacement: Modified trocar-free technique.

Transcatheter aortic valve replacement is established as the standard treatment for severe aortic stenosis. Many approaches have been described, including the suprasternal technique, an alternative for patients with unsuitable femoral arteries. We now describe a trocar-free technique for the Suprasternal approach. Under endotracheal anesthesia, an incision is made above the manubrium and dissection is carried down to the innominate artery with adequate exposure for cannulation. Access site is closed with purse-string suture. The Suprasternal approach has relatively few contraindications. Our trocar-free technique is a safe and easily reproducible technique for TAVRs in patients with poor femoral access.

Sutureless versus purse string with complete sac dissection in laparoscopic inguinal hernia repair in children: a randomized clinical trial

IntroductionPediatric inguinal hernia is a common surgical condition with a cumulative incidence of 4.2%. Minimal invasive surgery is playing a growing role in the treatment of this condition. We compared the outcomes of laparoscopic sutureless herniotomy and purse string with sac dissection repair with regards to complications and operative time.MethodsOne hundred fifty-two patients were operated on in two centers with two different techniques: sac dissection and purse-string suture, and sutureless repair. Operative time and recurrence were the main outcomes for comparison.ResultsSutureless repair has a shorter operative time (29 ± 10 min) compared to purse string repair (38 ± 13 min). The recurrence rate showed no statistical significance difference. However, the recurrence rate of sutureless repair was three times higher than that of purse string repair, and all recurrences were in large defects of 10–15 mm.ConclusionsSutureless repair is safe for defects up to 10 mm with excellent operative time. However, it had an unfavorable outcome in larger defects.

A Novel Ocular Tonometry Task Trainer.

The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry. We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice. The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}). We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.

Technical Challenges in Hysteroscopic Myomectomy with Prolapsing Cervical Fibroid

<h3>Study Objective</h3> To demonstrate various techniques to overcome challenges encountered during hysteroscopy myomectomy for multiple fibroids with concurrent prolapsing cervical fibroid. <h3>Design</h3> Stepwise demonstration using narrated video footage. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> A 44-year-old G4P2022 presented with heavy menstrual bleeding reporting heavier menses over the last few years. Pelvic exam demonstrated a 4 cm prolapsing cervical fibroid and a 12-week size multi-fibroid uterus. Pelvic MRI showed a multi-fibroid uterus with at least 30 myomas, including 5 submucosal fibroids measuring between 1-3 cm each. There was also a 3.7 cm pedunculated fibroid prolapsing through the cervix, into the vagina. Patient declined hysterectomy and opted for conservative surgical management. She underwent excision of prolapsing fibroid, hysteroscopic myomectomy, hysteroscopic endometrectomy, and levonorgestrel IUD placement. <h3>Interventions</h3> Below are strategies to remove multiple submucosal fibroids hysteroscopically when the cervix is dilated due to a prolapsing fibroid. 1. Two 0 PDS Endo-Loops are secured at the base of the prolapsing fibroid. The stalk is transected, and the fibroid is removed. 2. A purse string suture is placed around the cervix using 0 PDS and tagged with a hemostat at 12 o'clock. Once the hysteroscope is placed through the dilated cervix, the purse string suture is tightened, preventing leakage of hysteroscopic fluid. 3. Fibroids greater than 3 cm are enucleated at the base. Once the fibroid is free floating in the cavity, it can be grasped with a forcep and removed intact through the dilated cervix. Smaller submucosal fibroids are excised using hysteroscopic morcellator. <h3>Measurements and Main Results</h3> All submucosal fibroids were successfully removed with a minimal hysteroscopic fluid deficit. Patient tolerated the procedure well. <h3>Conclusion</h3> Multiple submucosal fibroids were safely and efficiently removed using the strategies above. A purse-string suture on the cervix prevents leakage of hysteroscopic fluid while maintaining uterine distension. Large fibroids were enucleated and removed intact through the dilated cervix.

Laparoscopic Redo Vaginoplasty with Uterine Buds: A Case Report

Study Objective To show that laparoscopic approach is beneficial for previously operated and failed modified Davydov vaginoplasty. Design A case report. Setting laparoscopy surgery with patient in lithotomy position under anaesthesia. Patients or Participants 20 years female diagnosed as a case of MRKH syndrome with single right sided kidney previously operated by modified Davydov surgery 6 months ago. Interventions Laparoscopic redo vaginoplasty by using uterine buds. Measurements and Main Results In modern era, endoscopy has replaced abdominal and vaginal approach of vaginoplasty. There is hardly any case report of Redo vaginoplasty done by vaginal or laparoscopic approach. Laparoscopic redo vaginoplasty by using uterine buds is done for the first time as per our knowledge and no such case has been reported in literature. The patient presented with complaints of shortening of vagina even with gradual vaginal dilatation. On per speculum examination, the vaginal length had shortened to about 2cm and width around 1.5cm. Patient was planned for redo vaginoplasty by laparoscopic approach. Intraoperatively, the lateral peritoneal flap on left side was tried but because of extensive fibrosis and shrinkage of peritoneum from previous surgery we proceeded with mobilization of Right sided uterine buds as a flap and used for creation of anterior vaginal wall. The vaginal vault was opened after difficult separation of bladder and rectum. The right uterine bud was mobilized into vaginal opening to form anterior vaginal wall and rectum pulled down to create posterior vaginal wall. Purse string suture was taken to create vaginal apex to create a vaginal length of approximately 8-10 cm. Vaginal mold placed and gradual dilatation done. At 1-year follow-up, patient had good anatomical and functional vagina of length 7-8cm. Conclusion Laparoscopic redo vaginoplasty using uterine buds can give successful outcome for failed vaginoplasty with added benefits of laparoscopic routes. To show that laparoscopic approach is beneficial for previously operated and failed modified Davydov vaginoplasty. A case report. laparoscopy surgery with patient in lithotomy position under anaesthesia. 20 years female diagnosed as a case of MRKH syndrome with single right sided kidney previously operated by modified Davydov surgery 6 months ago. Laparoscopic redo vaginoplasty by using uterine buds. In modern era, endoscopy has replaced abdominal and vaginal approach of vaginoplasty. There is hardly any case report of Redo vaginoplasty done by vaginal or laparoscopic approach. Laparoscopic redo vaginoplasty by using uterine buds is done for the first time as per our knowledge and no such case has been reported in literature. The patient presented with complaints of shortening of vagina even with gradual vaginal dilatation. On per speculum examination, the vaginal length had shortened to about 2cm and width around 1.5cm. Patient was planned for redo vaginoplasty by laparoscopic approach. Intraoperatively, the lateral peritoneal flap on left side was tried but because of extensive fibrosis and shrinkage of peritoneum from previous surgery we proceeded with mobilization of Right sided uterine buds as a flap and used for creation of anterior vaginal wall. The vaginal vault was opened after difficult separation of bladder and rectum. The right uterine bud was mobilized into vaginal opening to form anterior vaginal wall and rectum pulled down to create posterior vaginal wall. Purse string suture was taken to create vaginal apex to create a vaginal length of approximately 8-10 cm. Vaginal mold placed and gradual dilatation done. At 1-year follow-up, patient had good anatomical and functional vagina of length 7-8cm. Laparoscopic redo vaginoplasty using uterine buds can give successful outcome for failed vaginoplasty with added benefits of laparoscopic routes.

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

<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.