Laparoscopic transabdominal transvesical vesicovaginal fistula repair.
Publication/Presentation Date
4-1-2006
Abstract
BACKGROUND AND PURPOSE: Transabdominal transvesical repair has been the standard treatment for difficult vesicovaginal fistulae. We describe a laparoscopic transvesical technique that minimizes operative morbidity while adhering to the principles of transabdominal repair as described by O'Conner.
TECHNIQUE: The patient is placed in the lithotomy position using Allen stirrups, and bilateral 5F open-ended ureteral catheters are placed cystoscopically. Using four laparoscopic ports, the prevesical space is accessed. The bladder is bivalved down to the fistula, and stay sutures are placed at the bladder edges for exposure. The fistulous tract and adjacent fibrotic tissue are excised, and the bladder and vagina are closed separately with single layers of full-thickness interrupted 2-0 Vicryl sutures. An omental flap is interposed between suture lines in the bladder and vagina. The ureteral catheters are sequentially removed on the first and second postoperative days. A gravity cystogram is performed 3 weeks postoperatively; if it is normal, the urethral catheter is removed.
RESULTS: This procedure has been performed on two consecutive patients who had failed prior Latzko repairs. Both patients were discharged 2 days postoperatively without complications. At a follow-up of 41 months in the first patient and 39 months in the second, no fistula recurrence has been seen.
CONCLUSIONS: Laparoscopic transvesical vesicovaginal fistula repair appears to be a safe and effective procedure that adheres to the principles of a transabdominal transvesical fistula repair while decreasing morbidity and improving cosmesis. Continued follow-up is required to determine its long-term efficacy compared with the accepted open transabdominal and transvaginal approaches.
Volume
20
Issue
4
First Page
240
Last Page
243
ISSN
0892-7790
Published In/Presented At
Wong, C., Lam, P. N., & Lucente, V. R. (2006). Laparoscopic transabdominal transvesical vesicovaginal fistula repair. Journal of endourology, 20(4), 240–243. https://doi.org/10.1089/end.2006.20.240
Disciplines
Medicine and Health Sciences
PubMedID
16646648
Department(s)
Department of Obstetrics and Gynecology
Document Type
Article