Transperitoneal laparoscopic repair of iatrogenic vesicovaginal fistulas: Heilbronn experience and review of the literature.

BACKGROUND AND
PURPOSE: Vesicovaginal fistula (VVF) continues to be a distressing problem in urogynecology. Laparoscopy has become increasingly popular in the field of reconstructive urologic surgery. We describe our technique of laparoscopic VVF repair for iatrogenic VVFs, discuss our technique and outcomes, and review the related literature. PATIENTS AND METHODS: After hysterectomy for a benign condition, an iatrogenic VVF developed in three women (41, 48, and 34 years old, respectively) that persisted despite conservative therapy. Preoperative urethrocystoscopy demonstrated supratrigonal VVFs. Laparoscopic surgery was performed for the three patients after 3, 8, and 4 months of the previous abdominal operations. Patients were placed in a deflected supine position, and a transperitoneal five-port approach was used. The bladder was bivalved, and the fistula tract was excised. The fistulous tract was successfully repaired by closing the vagina and bladder separately. An interposing peritoneal flap was placed and fixed between the bladder and vagina.
RESULTS: The patients recovered uneventfully and were discharged from the hospital after 4, 9, and 5 days, respectively. Retrograde cystography on postoperative day 10 revealed no contrast leakage via the vagina. The urethral catheters were removed on the same day. After 30, 17, and 14 months of follow up, respectively, the patients were voiding without any urine leakage.
CONCLUSIONS: Laparoscopic repair can be applied effectively in the management of VVFs. The approach is safe and provides all advantages of minimally invasive surgery. Shorter hospital stay and shorter recovery time have a positive effect on the patients' well being.