Transperitoneal Transvesical Laparoscopic Repair of Vesicovaginal Fistulae: Experience of a Tertiary Care Centre in Northern India

Abstract

Objective: To present our experience of treating supratrigonal vesicovaginal fistulae by laparoscopic technique and their long-term follow-up. Material and Methods: Between January 2008 and June 2012, 28 cases of supratrigonal fistulas were repaired by laparoscopic transperitoneal transvesical technique with interposition flap. The obstetric fistula was present in 18 and gynecologic fistula in 10 patients. Single supratrigonal fistula was present in 26 patients and in 2 patients there were 2 fistulae lying side to side. The vaginal opening was closed as single layer interrupted suture and cystotomy closed as single layer continuous suture by 3-0 polygalactin. The omentum was used as interposition flap in all except 2 cases in whom postero-superior vesical fold of peritoneum was used. The open conversion was required in 2 cases. The urethral catheter was removed in 4 weeks following a micturating cystogram. Result: The mean fistula size was 1.2 cm (range 0.8-2.5 cm). Open conversion was performed in 2 cases of whom one had excess carbon-dioxide retention and cardiac arrhythmia and in another case the needle of 3-0 polygalactin was avulsed and lost in peritoneal cavity which was recovered following laparotomy. All patients were continent following the catheter removal. The median follow-up is 24 months. None developed any complication related to laparoscopic repair till last follow-up. Conclusion: Laparoscopic repair of supratrigonal vesicovaginal fistulae is an effective and safe minimally invasive treatment with excellent result.

Effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula

“…It was reported that blood loss in robotic surgery was significantly less compared to open surgery (88 vs. 170 mL) [17,19]. In addition, it was reported that blood loss ranges from 50 mL to 125 mL in various laparoscopic repair cases [18]. There was no notable blood loss in our cases.…”

“…In most cases, laparoscopic management of VVFs takes a relatively long time. The mean operative time in the literature ranges from 70 to 280 minutes in laparoscopic repairs and from 110 to 330 minutes in robot-assisted laparoscopic repairs [16][17][18]. The mean operative time in our study is 41 minutes.…”

“…The success rate in transabdominal and transvaginal approaches ranges from 65% to 100% [20]. The reported overall success rate in the literature is 86 to 100% for laparoscopic VVF repair [18,21]. Stovsky and colleagues [22] reported success in 11 of 15 patients by electrocoagulation of small fistula of <3.5 mm.…”

“…Increased number of ports and the internal dissections are the main causes of postoperative pain following laparoscopic repair. Four ports have been used in many studies about repair of VVF while more ports have been used in others [18]. In the present study, all cases were done using 2 ports only.…”

Urogenital fistula reviewed: a marker of severe maternal morbidity and an indicator of the quality of maternal healthcare delivery

“…Although minimally invasive surgery (MIS) such as laparoscopy and robotics is more accessible in high-income countries (HIC), a group in India is utilizing MIS to repair urogenital fistulae resulting from obstetric complications [ 28 ]. This group reportedly closed vesicovaginal fistulae with a single layer continuous laparoscopic suture with interposition of an omental flap; urethral catheters were left in situ for a month post-operatively [ 28 ]. As the capacity for MIS in LIC builds, it will be interesting to see how this experience contributes to the surgical literature.…”