Vesicovaginal fistulas: the transperitoneal repair revisited.

The experience in surgical repair of 18 complex vesicovaginal fistulas following abdominal hysterectomy is reviewed. The technique consisted in a transperitoneal approach and bivalving of the bladder. The fistulous tract was excised widely and the vagina closed transversely and the bladder longitudinally. In 10 patients, however, the bladder was closed in a Y-shaped fashion to avoid tension on the suture line. In 4 patients 5 ureters had to be reimplanted. There was one recurrence which was closed in a second attempt. For simple fistulas a simple vaginal approach is recommended. In complex fistulas including recurrences after vaginal repair a transperitoneal approach following the principles outlined will provide a high rate of success.