Laparoscopic Transabdominal Transvesical Vesicovaginal Fistula Repair

Shah, Shrenik

doi:10.1089/end.2009.0080

Cited by 45 publications

(17 citation statements)

References 5 publications

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“…Subsequently, laparoscopic repair. 11 and robot-assisted repair. 12 Successful closure of some cases of small size VVF with prolonged catheterisation have been reported by some authors.…”

Section: Discussionmentioning

confidence: 99%

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Datta¹,

Chattopadhyay²,

Mandal³

2016

jemds

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Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODSA total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21 st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULTOf the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSIONIn spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate, prevention of early marriage-all are of paramount importance for the prevention of occurrence of this socio-medical problem.

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“…Subsequently, laparoscopic repair. 11 and robot-assisted repair. 12 Successful closure of some cases of small size VVF with prolonged catheterisation have been reported by some authors.…”

Section: Discussionmentioning

confidence: 99%

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Datta¹,

Chattopadhyay²,

Mandal³

2016

jemds

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“…Nevertheless, the approach chosen should be that with which the surgeon is most comfortable (5,6) Laparoscopic VVF repair by different approaches has been described. Nezhat et al (7) were the first to report the laparoscopic retrovesical approach in 1994, which decreases the morbidity of the abdominal approach with similar success rates that range from 86% to 100% and minimal surgical trauma, allowing for more rapid convalescence (8,(10)(11)(12)(13)(14)(15)(16). Sotelo et al (8) reported an approach in which the bladder is first intentionally opened, accurately leading to the fistulous tract without requiring additional vaginal incisions or further dissection of the vesicovaginal space.…”

Section: Discussionmentioning

confidence: 99%

“…Sotelo et al (8) reported an approach in which the bladder is first intentionally opened, accurately leading to the fistulous tract without requiring additional vaginal incisions or further dissection of the vesicovaginal space. Thus, laparoscopy enables a limited cystostomy that improves upon the historically morbid O'Connor procedure, in which the bladder is bi--valved to the level of the fistula (12). Using the technological advantages of robotic technology (EndoWrist TM instruments with increased degrees of freedom leading to improved dexterity and absence of fatigue, three-dimensional [3-D] vision with improved depth perception, motion scaling, tremor filtration, higher magnification, and the surgeon's ergonomic position in a longstanding and time-consuming operation), it is possible to perform laparoscopic repair of VVF with robotic assistance, respecting the basic surgical principles of fistula reconstruction (17).…”

Section: Discussionmentioning

confidence: 99%

“…Once the fistula is identified, the vesicovaginal space is dissected to separate the structures; the importance of this technique lies in the intentional cystotomy for localizing the tract. The laparoscopic approach is primarily associated with similar success rates, minimal surgical trauma and reduced morbidity, allowing for more rapid convalescence (4,8,(10)(11)(12)(13)(14)(15)(16). Despite initial enthusiasm, laparoscopy has not gained popularity, most likely because laparoscopic VVF dissection and intracorporeal suturing are technically challenging.…”

Section: Introductionmentioning

confidence: 99%

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Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Objective: To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods:From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results: The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions:The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.

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“…Recientemente publicamos nuestra experiencia en la reparación laparoscópica de FVV en 8 casos demostrando ser un abordaje factible y seguro que puede reproducir los pasos de la cirugía convencional 5 . No obstante, al ser una patología infrecuente, las series publicadas son de pocos casos (Tabla 1) [7][8][9][12][13][14][15] . La serie con mayor Recientemente se ha incorporado a nuestros recursos quirúrgicos la cirugía robótica (da Vinci®) que es posible que pueda aportar ventajas comparativas o superiores a la vía laparoscópica 16,17 .…”

Section: Discussionunclassified

Cirugía laparoscópica de la fístula vesico-vaginal: resultados de una experiencia multi-institucional

P²,

et al. 2013

Rev Chil Cir

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Laparoscopic surgery of vesicovaginal fistula: results of a multi institutional experienceIntroduction: Vesico-vaginal fistula is a rare complication of gynecologic surgery, with a high rate of surgical resolution O'Conor open technique. Aim: To report the results of a multi-institutional experience in laparoscopic repair of vesico-vaginal fistula. Material and Methods: Between January 2006 and June 2011, 21 laparoscopic vesico-vaginal fistula were performed. The surgical technique, demographic variables and results are described. Results: The mean age was 45.6 years. The average time between the diagnosis of the fistula and the laparoscopic repair was 15.23 months. The mean total operative time (bladder and laparoscopic) was 153.12 minutes and the average hospital stay was 2.7 days. The average time of bladder catheter was 9.4 days. There was a minimal recurrence of a fistula, repaired by a vaginal approach. Urethrocystography revealed indemnity of the repair in the other 20 cases. The overall success rate was 95.2% (20 out of 21 patients) Conclusions: The laparoscopic approach follows all principles for repair of a vesico-vaginal fistulas. It look like a good alternative in the hands of experienced surgeons.

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Laparoscopic Transabdominal Transvesical Vesicovaginal Fistula Repair

Abstract: 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.

Cited by 45 publications

References 5 publications

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Cirugía laparoscópica de la fístula vesico-vaginal: resultados de una experiencia multi-institucional

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